HOM(EOPATHY
IN
VENEREAL DISEASES.
BY
STEPHEN       YELDHAM, M.R.C.S.,
SURGEON TO THE LONDON HOM(EOPATHIC HOSPITAL;
FELLOW AND VICE-PRESIDENT OF THE BRITISH
HOM(EOPATH1C SOCIETY; ETC.
(33
SECOND THOUSAND.
LONDON:
H. TURNER AND CO.,
77, FLEET STREET, E.C., AND 106, NEW BOND STREET, W.;
MANCHESTER:
41, PICCADILLY, AND 15, MARKET STREET.
1864.



Just Published, price 2s. 6d., Secrnd Edition,
HOM(EOPATHY
IN
VENEREAL DISEASES.
SBY
S. YELDHAM, M.R.C.S.,
SURGEON TO THE LONDON HOM(EOPATHIC HOSPITAL.
OPINIONS OF THE PRESS.
"The present work is unmistakably the production of a practical
man. It is short and pithy, and contains a vast deal of sound
practical instruction.  The diseases are briefly described; the
directions for treatment are succinct and summary. It is a book
which might with profit be consulted by all young and many old
practitioners of Homceopathy."-British Journal of Homoeopathy.
" We have no hesitation in recommending it to the favorable
notice of our readers."-Hommeopathic Observer.
" This excellent brochure will materially assist in filling up a void
in our Homoeopathic Literature for well-written essays on special
diseases."-zlAmerican Homoopathic Review.



PREFACE.
THE author does not profess to give, in this small
volume, an account of all the ailments incidental to
Venery. Such an undertaking would have carried
him far beyond the object he had in view, which
was, to place before his professional brethren the
conclusions he has arrived at, from    his own experience, in  the homoeopathic treatment of the
common Venereal diseases.
English homoeopathic literature is almost silent on
these diseases. Following, in his earlier practice of
homoeopathy, the few scanty directions contained in
" Jahr,' the author found that the results were not
so superior to those of allopathy, as he had expected.
Some modifications in the treatment were, evidently,
"necessary. Careful observation convinced him that



CONTENTS.
PAGE
VENEREAL DISEASES, introductory remarks on..    1
Balanitis......    2,,   treatment of....    4
Gonorrhea....         6,,    treatment of....    9
Gleet......   19,, treatment of.....   20
Bladder, irritation of....   23,,,       treatment of...  24
Erysipelas of the penis....   25
Chordee......   26
Testicle, inflammation of....   26
S 1..                treatment of...   27
Prostate gland, inflammation, and treatment of..   30
Stricture.....        33,,    treatment of....   34
Gonorrhoea in women....   37,,,,   treatment of...   38
Cases of the foregoing diseases...   40
PRIMARY SYPHILIS.....   53
Chancre, soft.....   55,,    hard.....   56
b



.VI


CONTENTS.


PAGE
Chancre, phagedenic...           57,,   urethral....   59
Primary syphilis, treatment of....   60
Bubo, and treatment of....   71
SECONDARY SYPHILIS....   74
S   of the skin, viz., exanthem..  80
papules..  81
pustules..  81
ulcers..  82
tubercles..  82
Secondary affections of mucous membranes..   82
Treatment of secondary syphilis...   84
~,    diseases of the mucous membranes.  89
TERTIARY SYPHILIS.....   92,,,,  of the bones....   92
Gummata......   93
Syphilitic sarcocele....   94
Syphilitic cachexia.....   95
Treatment of tertiary syphilis....   95
Cases of the foregoing syphilitic diseases.. 100



HOM(EOPATHY IN VENEREAL
DISEASES.
VENEREAL DISEASES.
THE general term   "venereal diseases" includes two
entirely different disorders-the one   called chancre,
syphilis, the pox; the other gonorrhoea, or, vulgarly, the
clap. These were formerly regarded as modifications'of
the same disease.    Later observation   has, however,
clearly established the fact that the two complaints have
their origin in two different poisons. They give rise to
different symptoms, lead to different results, and demand
different kinds of treatment.
The two diseases often coexist. They may be contracted at the same time, or the one may be superadded
to the other. This should not be lost sight of in examining a patient affected with a venereal disease. I have
more than once known a discharge from a chancre,
situated under a contracted foreskin, mistaken for gonorrhcea; and it is equally possible for the discharge from
gonorrhcea to obscure a chancre.    Hence it is indis1



BALANITIS.


the glans penis become red, with bub slight discharge;
in others, the whole of this part of the membrane, as well
as that lining the prepuce, will be found of the deepest
red, swollen, and velvety, thrown into rugTa, and discharging large quantities of pus. In these latter cases the
glands in the groin may become sympathetically affected,
but they seldom or never suppurate.      It is important
to distinguish this disease from syphilis on the one hand,
and gonorrhoea on the other. It is only where phimosis, congenital or acquired, exists, by which      the
secretions are retained under the foreskin, that there
is any chance of its being mistaken for gonorrhoea.
In this case the diagnosis may be decided by noticing
the source of the discharge. To effect this, the cavity
of the prepuce should first of all be well washed out
with warm    water, thrown up by a syringe.       Then,
retracting the foreskin so as to bring the orifice of the
urethra into view, it will at once be seen whether any
matter escape from it: if so, the irritation is distinctly
urethral; if preputeal, there will be no discharge for some
time after the part has been cleansed.
Again, it is not always easy, at first sight, to distinguish the ulceration which sometimes attends balanitis,
from that which ushers in an attack of syphilis. It is no
uncommon thing for the first outbreak of chancre to be
accompanied by a considerable amount of irritation of the
parts, and the appearance of several small superficial ulcerations, and it is only after this irritation has subsided,
that the real nature of the disease is declared, in the per



BALANITIS.


5


opposed surfaces of the inflamed membrane asunder. It
is well, also, to administer a dose of Aconite at bed-time,
and a pilule of the third decimal potency of 1fercurius
corrosivis or solubilis once or twice a day; and strict
abstinence from stimulating drink and food should be
enjoined.
When phimosis accompanies balanitis, it is difficult,
or impossible, to retract the foreskin for the purpose of
cleansing the parts and applying a lotion.    In these
cases the discharge should be washed away with a syringe
and warm water, and immediately afterwards weak Calendula lotion should be thrown up in the same way. These
means, combined with the administration of the medicines
I have just named, have never failed, in my experience,
to eradicate the disease.  Should the phimosis be congenital, and the patient be annoyed with persistent discharge, the propriety of dividing, or circumcising, the foreskin, may be considered. Contemplated matrimony may
render the operation desirable, but it is rarely, if ever,
demanded by balanitis. The contraction which, temporarily, it may give rise to, subsides with the irritation.



6G


GONORRTHIEA.
By this term is meant inflammation of, and a discharge,
from, the urethra. The discharge may arise from leucorrhoea in the female, or other exciting agents, but, as a
rule, it is contracted in intercourse with a person similarly affected.
Gonorrheea, like other diseases, varies infinitely in its,
intensity and duration, in different subjects. One case,
from first to last, will be so mild as scarcely to cause the
patient any annoyance beyond the simple discharge;
another will be attended with symptoms, both primary
and sympathetic, of the most painful description; and
between these extremes cases of every degree of severity
occur.
An average case of gonorrhoea presents four stages,
viz.The first, or initiatory stage, which lasts from twentyfour hours to a couple of days, and consists in a slight
tickling, or tingling, at the orifice of the urethra, and the
flow of a small quantity of thin, transparent mucus, or
milk-like discharge.
Secondly, to this succeeds the inflammatory stage, in
which the lips of the urethra become red and swollen,
the discharge becomes copious, thick and milky, yellow,
or greenish; the act of micturition is attended with pain



GONORIUHfEA.


7


and scalding, whilst erections and chordee torment the
patient at night.  During this stage, also, the most distressing of the complications of the disease are apt to
occur, such as irritation of the bladder, inflammation of
the testicle, and of the prostate gland.
The third stage, viz., that of subacute inflammation,
follows the subsidence of the foregoing acute symptoms.
It is marked by slight irritation in making water, and
the continuance of a discharge of yellow matter.   This
stage is apt to be protracted, and to result in theFourth stage, or gleet, which consists in the recurrence,
from time to time, of small quantities of discharge of a
transparent, or, more commonly, of a milky secretion.
This stage is usually unattended by any pain or irritation. But for the stain on the shirt, the patient would
be unconscious of anything abnormal. The discharge at
this period is said to lose its infectious property; but, as
the precise juncture at which the change takes place is
uncertain, no person, having a discharge on him, would be
justified in indulging his sexual passion, and thereby subjecting another to the risk of contagion.
The susceptibility to gonorrhcea varies greatly in different individuals, and under different circumstances.
Some persons hardly ever indulge in impure connexion
without contracting gonorrhoea; others, though not a
whit more virtuous or careful, escape infection altogether.
This greater liability to the disease in some persons than
in others, is doubtless mainly due to different degrees of
natural sensitiveness in the mucous membrane lining the



S


GONORRHCEA.


urethra. There is, also, an acquired insusceptibility to
gonorrhcea. Repeated attacks render the mucous membrane of the urethra comparatively insensible to the
gonorrhoeal virus. The first attack is generally by far
the most severe; whilst subsequent attacks are often
attended with but little suffering or inconvenience.
Prognosis.-There are no points in the history of
gonorrhoea on which it is more difficult to pronounce an
opinion than the probable course, duration, and result of
an attack of gonorrhoea. From some unforeseen cause
or other, the most carefully-weighed prognosis will often
be falsified. One case will get well in a few days; another,
in spite of the most careful treatment, will assume the
most aggravated character, develope all the complications
of the disease, and hang about for months. A case of
this description has recently been under my care. The
patient was of a fair, phlegmatic temperament.      The
attack continued in a mild form for some time; suddenly,
inflammation of the prostate supervened; then the bladder
became affected; to this inflammation of the testicle succeeded; and lastly, distressing irritation of the lower bowel.
I have witnessed many such cases. A scrofulous constitution, and an irritable nervous temperament, are the chief
predisposing causes of these aggravated and obstinate attacks. It should, therefore, always be borne in mind, and
the patient, if necessary, should be made acquainted with
the fact, that however mildly an attack of gonorrhea may
set in, however promisingly it may for a time progress,



GONORRH'EA.9


9


it is a disease liable, at any moment, to serious complications, which, in the most skilful hands and under the
best system of medicine, may protract the treatment to
an almost indefinite period.
Treatment.-We have now to consider the most important point in the history of gonorrhcea, viz., its treatment.
It is here that the old and the new systems come into
comparison. It is an interesting fact, that the practitioners
of the old system have arrived nearer to the truth in the
treatment of venereal than of any other class of diseases.
All their principal remedies in those disorders are specifics; in other words, homoeopathic remedies.    Thus,
mercury is the universally admitted specific for syphilis:
it is used by the practitioners of both schools; and so
also, copaiba, cubebs, and turpentine, are true specifics
for gonorrhoea. The great difference consists in this:
that the old school, whilst they cure their patients, poison
them with enormous and disgusting doses of the remedies;
the homoeopath, on the contrary, whilst he equally cures
his patient, saves him from the painful penalties of the
remedy, and, in addition to this, as we shall presently see,
he possesses other and better remedies, of which the allopath is ignorant, or of which, at all events, he makes no
use. Herein consists our great superiority. I do not
wish to rob my allopathic brethren of one iota of credit
which is their due, nor to claim for homccopathy any
superiority to which it is not fairly entitled. I am ready
to admit that, if a patient can make up his mind to



GONORRHtEA.


13


allopathic surgeon. To do any good, it must be given
in palpable doses. I am in the habit of prescribing from
five to ten, or even fifteen drops of the mother tincture
three or four times a day. In my own practice, the
dilutions have proved nearly, if not quite, inert.
Copaiba is a powerful homoeopathic remedy in gonorrhbea; but, unfortunately, whilst, like Cannabis, it requires to be administered freely, unlike that medicine, it
is so objectionable in taste and smell, and in its effects
upon the stomach, as to be often more intolerable to the
patient than the disease it is given to cure. To obviate
this difficulty, capsules of various kinds have been invented, and, as they answer the purpose of hiding the
taste and odour of the drug, they present the best form
in which it can be exhibited, when that medicine is
deemed necessary.   Copaibca is directed in some homoeopathic books to be given in the ordinary homceopathic
dose. A   careful watching of its effects in many cases,
where so administered, has satisfied me that in infinitesimal doses it is perfectly useless.
This opinion is supported by some interesting experiments made by Ricord, which go to prove that Copaiba acts,
not dynamically, as most of our medicines are supposed to
do, but by mixing with the urine, and so coming directly
in contact with the diseased membrane. Ricord says:" We have had occasion to treat gonorrhoea in patients
who suffer under urethral fistula at two inches, or two
and a half inches from the meatus. In one of these cases
blennorrhagia occurred in the vesical portion of the canal,



GONORRHMEA.


15


homoiopathic medicines-Cannabis, for example-in the
treatment of gonorrhcea.
Thuja, is a remedy closely allied in its action to Cannabis, and may be prescribed in the same class of cases,
and at the same stages of the disease, as that remedy. It
is particularly indicated if, during or after the existence
of discharge, warty growths present themselves on the
corona glandi. or foreskin, or about the anus.
The foregoing are the medicines on which, in the vast
majority of cases, reliance may be placed in treating acute
gonorrhcea. I have seldom found it necessary to travel
beyond them. Yet, cases do sometimes happen in which,
from the obstinacy of the disease, or from the prominence
of some particular symptom, it is found requisite to
employ other medicines. The chief of these are Sulphur,
as an antipsoric in intractable cases, occurring in scrofulous constitutions; Capsicum, when the burning along
the urethral canal is intense; Nux vomica, when the
digestive functions are disturbed, and when the irritation extends to the rectum, causing frequent and distressing urging to stool, with the protrusion of piles.
Two or three drops of the second or third decimal dilution
of these medicines may be administered every six hours.
Other medicines recommended are - Agnus castus,
Argentumr  nitricum, Cubeba, Petroselinum, Pulsatilla,
Bhus Tox., Miezereum, Ferrum.      I have occasionally
employed some of these, but not with any very decided
results.
Injections.-Local applications in the form of injections,



16


GONORRHCEA.


though repudiated by homceopathic authors generally,
appear to me indispensable in the treatment of some cases
of gonorrhea. The prejudice against them on the part
of homceopathic practitioners is based, in the first place,
on the groundless fear of causing stricture; and secondly,
on the equally erroneous notion that they are antihomeopathic. The former of these objections I believe
to be totally unsupported by facts. The common cause
of stricture is that chronic irritation which follows an
acute attack of gonorrhoea, in which the whole course of
the urethra, from the orifice to the bladder, is implicated.
The speedy cure of this irritation is the greatest safeguard
against stricture; and it is beyond a question that injections, used with care and at the proper time, afford the
readiest means of accomplishing that object.
The second objection, viz., that injections are unhomceopathic is equally untenable. On the contrary,
they appear to me to be truly homceopathic in their
action.   Gonorrhcea is inflammation of the urethra;
injections should be weak and unirritating solutions of
medicines, which in their concentrated form will, when
locally applied, produce inflammation of the urethra!
If this is not homceopathy, what is it? and even if it
were not so, a case of gonorrhoea, in the speedy cure of
which interests of the deepest import to the patient
are often involved, is the last over which it would
become the medical man to split straws on points of
doctrine. The only question he has to consider is, by
what means he can most speedily and safely cure his



GONORRH(EA.


17


patient?  The rejection of the valuable assistance which
injections afford, places the homoeopathic practitioner at
a great disadvantage in treating gonorrhoea.
Injections, like all other remedies, to be efficacious,
must be well timed and well chosen.         As regards
the former of these points, there are two periods in
the course of an attack of gonorrhcea in which injections are admissible, viz., the earliest, or initiative
stage, and the later, or subacute stage.    The former
of these extends over the first twenty-four or forty-eight
hours, and comprises that period when there is simply
slight itching, and perhaps some mucous discharge, and
before the more acute and inflammatory symptoms have
had time to develop themselves. At this juncture an injection of a mildly astringent character, used frequently,
will sometimes succeed in arresting the further progress
of the disease. I do not here recommend, or approve,
the violent caustic lotions which the allopathic school
employ under the unfortunately appropriate name of
"the abortive plan;" neither do I think that, as a rule,
injections should be used in the early stage of firsb claps,
which   are generally much more acute than        subsequent attacks, and which, in spite of all that can be done
to check them, will almost invariably pass through the
regular stages of the disease. But, in those cases in
which the symptoms are mild from the commencement,
which manifest no disposition to become acute, whjch
occur in phlegmatic constitutions, and in which the
patients have been previously affected, injections may be
2



18


GON ORRHZEA.


advantageously employed from an early period of the
disease. Not only do they, under such circumstances,
not aggravate the disease, but they contribute to a much
more speedy cure than could be effected by medicines
alone.
The second period in which injections are admissible
is that which succeeds to the inflammatory stage of
acute attacks. It is here that injections find their most
appropriate place. Great caution, however, should be
observed not to inject too early. As a rule, the inflammatory symptoms should all have subsided.        There
should be no scalding or irritation of the bladder, and
the discharge should have sensibly diminished. The
disease should, in short, be decidedly on the wane. Injections should be resorted to only after medicines,
steadily persevered in, have failed to cure the discharge.
They are then both safe and necessary.       Employed
earlier, they may increase the existing irritation, and
render the membrane insensible to their action when,
at a later period, their employment might be indicated.
As regards the composition of injections, this is a
point which must be decided by the experience of the
medical man. The medicines suitable for the purpose
are various.  I am myself in the habit of employing
mainly the two following, viz., infusion of Hydrastis
Canadensis, and the Liquor Pliumbi diacetas. Both of
these are excellent remedies, and they appear to be very
similar in their action. I use them almost indifferently,



GLEET..


19


substituting the one when the other fails.     Properly
diluted, they are unirritating, and simply soothing and
curative in their effects. I generally order half a drachm
of the Liq. Plumzbi to an ounce of distilled water, and
the infusion of Hydrastis in the proportion of an ounce
of the drug to a pint of water. I have frequently succeeded in curing, by means of one of these injections,
or even by cold water only, discharges which had resisted the use of the strong injections ordinarily employed by allopathic surgeons. The mode of injecting
is a point worthy of attention. The syringe should have
a good long nozzle, which should be well inserted into
the urethra. The injection should be retained for two
or three minutes, by compressing the penis between the
finger and thumb of the left hand, whilst the instrument
is withdrawn with the right. It is well to try the effect
of the injection every night in the first instance, and if
it agree, repeating it more frequently afterwards, if necessary.
During an acute attack of gonorrhoea, the patient
should live on light and unstimulating food, and strictly
abstain from  all stimulating drinks, and, as far as practicable, avoid active exercise. Nothing favours recovery
from an attack of this kind more than perfect quietude
in the recumbent posture.
GLEET.--Consists in    the continuance, after all inflammatory symptoms of gonorrhoea have subsided, of a



20


GLEET.


discharge from the urethra, of a fluid varying ih colour
and consistency-being in one case simply mucous, in
another, purulent..The quantity is generally small, often,
not more than a few drops in the course of twenty-four
hours; whilst at times it ceases entirely for days together,
returning without assignable causes, or in consequence
of some excitemient in the way of diet or exercise.
Though most commonly the result of an acute attack of
gonorrhoea, mild cases of that disease, also, not unfrequently run on, and assume the true characters of
gleet.
The sources of this discharge are various.  In some
cases it issues from the lacuna magna, situated a short
distance up the urethra. When that is the case, a drop
of the discharge may almost at any moment be obtained,
-provided the patient has not recently passed water-by
squeezing the end of the penis. In other cases it may
proceed from chronic relaxation of the membrane higher
up the passage towards the bladder, or from the prostate
gland, or, more commonly still, from a stricture. This
last point may   be determined by exploration with a
bougie. If no stricture exist, and the drop, as I have just
described, cannot be squeezed from the orifice, and if
injectipns used in the ordinary way fail to arrest the
discharge, we may infer that the disease has its origin
in some irritation or relaxation of the deeper-seated portions of the urethra.
The treatment of gleet must be both general and local.



GLEET.


21


The general treatment consists in the exhibition of such
medicines as tend to allay irritation, and restore the
tone of the urinary passages. Of these the most appropriate are the 'following: -Cantharis, iMercurius, Nux
vomica, Pulsatilla, and Sulphur. A variety of other medicines have been recommended, but the foregoing are those
from which experience has taught the homoeopathic surgeon to look for the most decided effects. The symptoms
of gleet, irrespective of the discharge, are of so negative a
character, that it is difficult to lay down any precise
rules for the choice of any particular remedy.      The
selection must be determined as much by the constitutional as by the local symptoms. Gleet is very commonly found associated with a depressed state of the
general health.   In this case, Nzux vomica and Sulphur
will be found of the utmost service.  I have frequently
witnessed the entire disappearance of the discharge, under
the steady use of these two remedies, In cases where
Mlfercury has been deemed necessary, I have found Cinna.
haris the most useful preparation. Pulsatilla is a good
remedy in chronic affections of the urinary organs, and
is well suited to phlegmatic and scrofulous constitutions.
PFerrumn in the form of Tinct. Ferri Sesquichlorid., in tendrop doses three.times a day, is at times efficacious,
in gleet occurring in debilitated constitutions. Whatever
the remedy, it should be persevered with steadily; and in
all cases it is desirable to combine with medical treatment,
the invigorating influence of change of air, to live temperately and nutritiously, and to practise local or general



GLEET.


bathing with tepid or cold water, according to the powers
of the patient.
Of all the stages of gonorrhoea, gleet is that which is
most benefited by injections. Indeed, there are many
cases in which all other means without this seem powerless. If the disease be confined to the lacuna magna,
an injection used in the ordinary way will answer every
purpose. If the discharge originate in irritation higher
up the urethra, the injection should be applied by means
of a catheter of sufficient length to reach the affected
part. The distal end of the instrument should be pierced
with a row of small holes, through which the injection,
thrown up from an elastic syringe, may escape, and come
in contact with the affected membrane. The disadvantage
of this mode of injecting is this, that it cannot conveniently
be accomplished by the patient himself, and necessitates
daily attendance on a medical man. It is, therefore, better
suited to hospitals than to private practice.
"Chronic thickening of the lining membrane of the
urethra, in some cases amounting to stricture, in others
to mere irregularity of the canal, is a common source of
gleet; and the restoration of the passage to its normal
size, by the careful introduction of the bougie, is the
proper mode of curing the discharge. When, therefore,
after a fair trial, all efforts to arrest the discharge by
medicines fail, a bougie should be introduced, and the
passage explored. It may be that no well-defined stricture will be detected, but only a halting in the progress
of the instrument, as if passing over some irregularities,



COMPLICATIONS OF GONORRH(EA.


23


These cases, equally with completely formed stricture,
yield to the use of the bougie. It is sufficient to repeat
the operation every third day, or, in some cases, once a
week, and the instrument should be allowed to remain
not less than from a quarter to half an hour; a more
frequent introduction is apt to set up violent irritation
in the passage.
Appropriate medicines, such as I have before indicated, should at the same time not be omitted.
COMPLICATIONS OF GONORRIt              (EA.
By this term is meant, those affections which, forming
no essential part of gonorrhoea, yet owe their origin to
that disease, and require distinct treatment. The chief
of these are, irritation and inflammation of the bladder,
of the testicle, and of the prostate gland, phimosis,
chordee, and erysipelas of the penis.
IRRITATION OF THE BLADDER.-This is a common,
and, at times, a very distressing accompaniment of
gonorrhoea. Few acute cases are entirely free from it.
It commonly comes on early in the disease, being coincidental with the most inflammatory stage of the attack.
Its leading symptom is a painful, and, in some cases, an
almost incessant urging to pass water; and the suffering



2.       COMPLICATIONS OF GONORRH(IA.


is often greatest the moment after the bladder has been
emptied.   The urine is generally loaded with mucus,
and, in some cases, is intermixed with blood. In milder
cases there is simply a slightly increased frequency in the
desire to micturate, or, it may be, a suddenness only in
the call, when it occurs at the regular intervals.  In the
severer cases the patient complains of a constant aching
pain in the region of the bladder, and there is evidence
of general constitutional disturbance, in   accelerated
pulse, loss of appetite, and sense of weakness.
'Trealment.-The remedy for the original disease will
often be the most appropriate for this; yet, if the patient
is not at the time taking Cantliaris, that medicine, in
one-drop doses of the third tincture, in alternation, every
four hours, with a like dose of Aconite, should be administered. These two remedies will seldom fail, in a few
hours, to subdue the more violent symptoms, even if they
do not entirely allay the irritation. When these fail,
Belladonna may be had recourse to with great advantage.
A drop of the second or third decimal dilution every two
hours should be given. NiLx rom*ica, Puzlsatilla, and Slphur, are also useful remedies in obstinate cases. The,Spirit of Cuamphor, in six-drop doses, in water, repeated
every two or three hours, will sometimes afford speedy
relief from violent and spasmodic urging to make water.



COMPLICATIONS OF GONOItRRH(EA.


PIiuMosis.-This is    not a frequent occurrence of
gonorrhcea, and when it does occur, it is of slight inconvenience, being much less complete and obstinate than
when it results from chancre. In some rare cases, however, the foreskin becomes thickened and constricted,
difficult to be retracted, and the discharge may accumulate under it and irritate the glans penis. This occurs
more frequently, however, in cases of congenital phimosis. In either case, the discharge should be washed
away from under the prepuce two or three times a day,
by means of a syringe and warm water, and the end of
the penis may be enveloped in wet rag, and covered with
oil-silk.  The remedies which cure the gonorrhoea will,cure the phimosis also, if it be not congenital.
ERYSIPELAS or THE PENIS.-Not uncommonly, during
the earlier and severer stages of gonorrhea, the prepuce,
and integuments of the body of the penis, are attacked with
erysipelatous inflammation. The whole organ becomes
red, inflamed, and swollen. The patient is often much
alarmed at this condition; it is, however, attended with
but little pain or inconvenience, beyond the bulkiness of
the organ. It yields kindly enough to the exhibition of
Belladomna and Apis-administered in drop doses of the
second or third decimal dilution of the tincture, every
four hours, omitting, in the mean time, any other medicine
which the patient may be taking for the gonorrhca.. It
is well here, also, to envelope the penis in wet cloths,
under oil-silk.



26        COMPLICATIONS OF GONORRH(EA.


CHORDEE, and other erections, which occur during the
acute stage of gonorrhcea, though not otherwise important, often harass and distress the patient at night,
and prevent sleep. When this is the case, his diet should
be simple and spare, he should lie lightly covered; the
penis should be wrapped in cloths soaked in cold water,
to which a few drops of the mother tincture of Aconite
may be added, and a drop of the third decimal tincture
of the same medicine should be taken two or three times
during the night, if required.
INFLAMiMATION OF THE TESTICLE-OCHITIs.-This
is one of the most severe and painful of the concomitants
of gonorrhea, and may supervene either during the
acute or chronic stage of that complaint. One of its
earliest symptoms is, often, a hard, stunning headache. This will sometimes come on and last twentyfour hours before any signs of the local disease are
manifest; and when, in the course of an attack of
gonorrhcea, this symptom is complained of, the surgeon should be on the watch for that which is in all
probability about to succeed-an attack of orchitis. This
headache, however, is only occasional.   The constant
symptoms are, pain, swelling, and extreme tenderness of
one of the testicles. The organ continues to swell during
the first two days, and sometimes attains to the size of
a small closed fist. There is generally redness of the
scrotum, and often pain in the spermatic cord, extending



COMPLICATIONS OF GONORIRHEA.


27


from the testicle up to the groin, and round the loin of
the affected side, and the cord becomes much thickened.
A  case was admitted into the London Homceopathic
Hospital last year, in    which   the swelling assumed
many of the characters of scrotal hernia, and might
have been mistaken for that disease, but for the fact
that the man still had the remains of an attack of
gonorrhoea.
The pulse in these cases is small, quick, and jerking;
there is shivering, thirst, and loss of appetite.
The discharge from the urethra becomes greatly diminished, or ceases altogether, during the height of the
attack. It commonly returns to some extent, as the
inflammation of the testicle subsides.
Treatment.-As regards the treatment of inflammation
of the testis, there is nothing more surprising and satisfactory in the circle of medical practice, than the certain
and powerful influence exercised over this complaint by
homoeopathic remedies. It is difficult for the medical man,
who understands the nature, intensity, and obstinacy of
the disease, to credit the effects of these remedies, without
witnessing them.     They are the more striking when
viewed in contrast with the treatment under the old
regime. See a man in the latter situation. Here is the
programme:-Purgatives to empty the bowels; tartar
emetic to make him sick; the lancet, or leeches, to relieve
him of his blood; calomel and opium to make his mouth
sore; fomentations, astringent lotions! As I have said,



-285 C031PLICATIONS OF GON0RRHOE A.


the contrast between this and the effects of homoeopathic
medicines, is something really wonderful.
Aconite is the chief remedy. It should be commenced
as soon as the first symptoms of the disease declare
themselves, and be continued for twenty-four or thirtysix hours, in drop doses of the second or third dilution,
every three or four hours. This medicine alone will, in
many cases, effect a complete cure. It is well, however,
after the constitutional and more urgent local symptoms
have been subdued, to have recourse to
Pulsatilla.-I prefer the second or third decimal dilution, and it should be repeated every three or four hours.
It may be found necessary to administer an occasional
dose of Aconite, whilst the patient is under the action of
Pzlsatilla. These two remedies rarely fail to afford speedy
relief. They should not be relinquished too hastily, if
the amendment is not so rapid as the surgeon might at
first expect. In the end, the cure will be effected earlier,
than if he run impatiently from one remedy to another.
During the height of the attack the patient should
remain in the recumbent posture, and live on fever diet.
When he gets up he should support the testicles in a
suspensory-bag.   The swelling of the gland, which
remains as a temporary effect of the inflammation, will
subside of itself in the course of a few days, or its reduction may be expedited by the exhibition of Mfercurius
and Sultpkiur.
I have rarely found it necessary to resort to any other
than the first two remedies, viz., Aconite and Pudsatilla;



32        COMPLICATIONS OF GONOrRHA.


again in the course of the night, if the patient is feverish
and restless. I may here state that, instead of alternating medicines every dose, it is often preferable to give
one kind during the day, and the other during the nightMedicines are less interrupted in their action, and each
one has a better opportunity of producing its specific
effect, when given in this way, than when changed more
frequently.
The more active symptoms being subdued by the foregoing medicines, Eali liydriodicwz  comes in with excellent effect, in controlling the subacute and chronic stage
of the disease, which is apt to succeed. It should not be
given in too minute a dose. I have, myself, obtained the
most marked results from one-grain doses of the salt
every four or six hours. ThJina, Argentum, Aurwum, Calcarea, and a host of other remedies, are quoted as applicable to this complaint. They may occasionally be useful,
but I am satisfied that we do better by adhering steadily
to a few well-tried medicines.
If suppuration take place, the matter may discharge
itself either into the urethra or rectum; or the cellular
tissue surrounding the gland may become implicated, and
matter may form andpoint in the perinaum. In this case
it must be evacuated with a lancet, as soon as fluctuation
can be detected.



33


STRICTURE.
By this term is meant a narrowing of some portion of
the urethra, by which its capacity is lessened, and the
flow of urine from the bladder impeded. The common
cause of stricture is the inflammation attendant upon
acute gonorrhoea, in which disease the whole length of
the urethra is generally involved; and if the constitution
of the patient be bad, and the recovery slow, chronic
inflammation supervenes, and permanent thickening of
the lining membrane is the result. The stricture may be
situated in any part of the urethra, but its most
common, seat is the membranous portion, just under the
symphisis pubis. There may be one or several strictures, and the whole, or a portion, only, of the circumference of the canal may be implicated. In some cases
a thin band only of the lining membrane will be stretched
across the canal; in others, the strictured portion will
occupy as much as half an inch of the length of the urethra.
The symptoms vary in severity with the degree of stricture. The earliest symptom is ordinarily an increased frequency in the desire to empty the bladder, or the retention
of a few drops of urine, which dribble away afterwards;
and, on cooling, the urine deposits a cloud of mucus.
The obstruction in voiding urine increases with the
growth of the stricture, and the stream becomes smaller,
3



34


STRICTURE.


twisted, and split. In almost every recent case there is,
also, a gleety discharge.   Indeed, the obstinate persistence of this discharge, is one of the most unfailing
signs of the existence of stricture. In aggravated, and
long-standing, and neglected cases of this complaint, the
patient's sufferings are sometimes truly distressing. The
irritation extends to the other urinary     organs-the
bladder becomes disorganized by the action of offensive
ammoniacal urine, from the irritating presence of which
it is never free, and ultimately the kidneys become involved in the destructive process. The patient is constantly impelled to fruitless efforts to empty the bladder,
his rest is thereby broken, his appetite fails, his general
health becomes broken, and unless timely relief is afforded,
hectic succeeds, and he sinks under an accumulation of
evils. A case of this nature, though, happily, fortunate
in its termination, will be found amongst the cases at the
end of this section.
What is called spasmodic stricture seems to be simply
an aggravation of an already existing stricture, by some
exciting cause, such as sudden cold, over-indulgence in
alcoholic drinks, and the like.
Treatment.-The indications are to reduce any existing
inflammation, and to restore the passage to its normal
size.
In some recent cases, in which the obstruction to the
flow of urine depends on simple tumefaction of the membrane, medicines alone will suffice to remedy the evil, or



GONORITHCEA IN WOMEN.


37


Aconite and Cantharis when there is much irritation of
the bladder, or tenderness in the seat of stricture; Mercuris when there is purulent discharge; Nux vomnica
and Sulpihur in the more chronic form of the disease,
when there is derangement of the digestive functions, and
in weakened and scrofulous constitutions.
The following medicines, may, also, under particular
circumstances be employed with advantage, viz., Clemnatis,
Ocinabis, Silicea, Pulsatilla, Thuja.
GONORRHCEA IN WOMEN.
The remarks that have been made on the subject of
gonorrhea in males, apply equally to women; but few additional words, therefore, are required here. The differences in the disease as it affects the two parties, respectively, are due to the different conformation of their genital
organs. In women it is a much milder and more manageable disorder than in men. The female escapes much of the
suffering, and most of the complications, that render the
disease at times so painful and protracted in men. Indeed, so slight in many cases is the inconvenience which
women undergo, that they are, from first to last, happily,
ignorant of its nature, and attribute the discharge to
which it gives rise, to leucorrhoea, or some other uterine,
affection. In other cases the symptoms are more marked



38


GONORKRHGEA IN WOMEN.


and indicate inflammation of the vaginal passages and of
the bladder. There is redness, swelling, and heat of the
external parts, attended, after a longer or shorter period,
by a mucous, or milky, or yellow discharge. The inflammation, when intense, leads to erosions of the membrane,
which cause much pain as the urine flows over them. In
most cases the urethra is involved, and there is scalding.
in making water, and if the bladder becomes affected,
there is frequent desire to micturate, with the emission,
in severe cases, of small quantities of blood.
Much stress is laid by some authors on the difficulty
of distinguishing this disease from other vaginal discharges, and the use of the speculum is invoked to clear
up the diagnosis. I believe this difficulty to be overstated. The persistent heat and tumefaction of the external parts, the irritation of the bladder, together with
the ordinarily undisturbed state of the patient's general
health, sufficiently distinguish gonorrhoea from that
irritation which attends, intermittingly, upon uterine
disease, and in which the general health is, also, commonly,
impaired.
Treatiment.-The - same circumstances which render
the disease in women less painful and complicated than
in men, render it also much more amenable to treatment. Local remedies are more to be relied on, and in
many cases are alone sufficient to effect a cure.
"While the inflammatory symptoms run high, free
bathings with cold or tepid water should be enjoined,



GONORRlHEA IN WOMEN.


39


and  at the same time Aconite and         Aliercurius, or
Cantharis, should be administered internally.   As the
symptoms become mitigated, Cannabis may          be resorted to, and a lotion of Lead, or Hydrastis, or Alumina,
may be employed as an injection. This should be used
several times a day. Care should be taken to throw it
well up the vagina, for the disease commonly penetrates
beyond the reach of sponges or cloths, with which some
patients will persist in applying the lotion.
The indications for the different medicines are much
the same as those which have already been pointed out in
describing the treatment of gonorrhcea in the male,
viz.Aconite, when there is heat and swelling of the external organs, with irritation of the bladder and frequent
desire to pass water.
Cantharis, if there is frequent urging to micturate,
with heat and pain in the act, or when, these symptoms
being absent, there is burning heat of the external parts,
with or without discharge..Mercurius corrosivus, when, these more urgent symptoms
having been subdued by the foregoing medicines, there
still remains heat, with a milky or yellow discharge.
This combination of general and local treatment seldom
fails to eradicate the disease in the course of a few days.



40


CASES.


The following cases, selected from a large number, are
introduced for the purpose of illustrating, practically,
the leading points in the foregoing remarks.
It was my first intention to introduce the different
cases immediately after the diseases to which, respectively, they belong. But, as the complications of gonorrhcea are so constantly mixed up with the original
disease, it has appeared to me more appropriate to group
the cases all together, and so preserve that unity, and
natural connexion amongst them, on a view of which
much of their practical value depends; and, at the same
time, avoid the tiresome repetition which a different
course would, inevitably, have entailed.
CASE.-Balanitis, mistaken for Gonorrlhoa--Chancre.
June 25th.- --, et. 24. Has had a chancre a week, on the
franum preputii, and two smaller ones. The whole membrane
covering the corona glandis, and the adjacent part on the prepuce, is
terribly inflamed, and discharging a quantity of pus. He has been
treated for clap, and has had balsam of copaiba, which he could not
keep on his stomach.
Take Mer. solub. %, gr. iij, ter die. To wash away the matter
from under the foreskin with syringe and warm water, and then
throw up Calendula lotion, the foreskin being thick, inflamed, and
very tight, and painful to retract.
29th.-Considerable improvement. Continue.
July 9th.-Still progressing favorably. Continue.
15th.-The chancre still felt, hard, through the foreskin. The
discharge from under the prepuce almost entirely subsided-scarcely



CASES.


41


more than would come from the chancre. He continued the lotion
and the Mer. sol., and got steadily well, without any untoward
symptom, either then or afterwards.
This case is a practical illustration of an error in diagnosis, which has before been alluded to as possible, if care
be not observed, viz., mistaking the discharge from an
inflamed foreskin for gonorrhoea.
CASE II.-Balanitis-Gonorr1coea-lErysipelas of Penis, and Crabs.
June 17th.- -, mt. 24. Had connexion a month since. The
discharge first appeared a week ago. It is now copious and milky,
and there is scalding after passing water.
Take Copaiba X, gtt. xv, ter die.
25th.-The discharge considerably less. The scalding nearly as
much. Continue.
July 3rd.-The last time he visited me he had a wash, composed of
two grains of Hydr. bichlor. to an ounce of water, for a colony of
crabs, which were destroyed by two applications of the poison. He
has now a copious purulent discharge from the under side of the
prepuce, the result of inflammation set up by the accumulation, in
that situation, of smegma and gonorrhoeal discharge. The foreskin
is swollen by an attack of erysipelas, evidently originating in the
balanitis.
To have Bell. and Mere. corrosiv. tinctures, x, alternately, once
in six hours. Apply cold cloths to penis.
13th.-The above symptoms have subsided. Still some gonorrhceal discharge.
To take Tinct. Cannabis 0, gtt. x, ter die, and use Lotio Plumbi
as injection. With this treatment he got quite well in a few days.
CASE III.-GonorrlAa, with Balanitis and Ulceration.
December 7th.-   -, at. 24. Eight days a yellow discharge
from the urethra, having had sexual intercourse six days previously.



42


CASES.


Six days ago a superficial ulcer appeared on the corona glandis,
He applied Caustic to it, and it is now sloughy at the bottom. The
whole lining membrane of the prepuce is inflamed, and there are
other superficial ulcerations on the glans. He has had Cannabis
three times a day, and the discharge had nearly ceased until to-day.
Take Mere. corrosivus j, ter die, and apply Calendula lotion, on
cotton wool, to the prepuce.
12th.--The large ulcer, which was touched with Caustic, healed;
and the inflammation of the glans and prepuce has nearly disappeared, with the exception of one small soft ulcer on the edge of the
prepuce, which does not heal. There is still some discharge and
slight irritation. Continue medicine, and have RTydrastis infusion
to inject.
17th.-The discharge, the next morning after the fydrastis injection, seemed to have gone as by magic. He has used it three
times a day. There is now the slightest discharge. The ulcer is
not quite healed. The granulations are weak, and bleed every
morning, when the dressing is renewed. Touch them with Caustic,
and continue the medicine.
26th.-The ulcer has healed. He took wine yesterday, and today the prepuce has become inflamed, is discharging yellow matter,
and there are some superficial ulcerations. Take Nitric acid X,
gtt. v, ter die, and apply Calendula lotion.
January 9th.-The irritation, though much less, continues, and
the ulcerated spots are a little elevated. Take Mer. sol. 2, gr. ij,
ter die.
21st.-The ulcers healing rapidly. The irritation ahnost entirely
subsided. Continue.
31st. The gonorrhcea well. The ulcers healed. The irritation
also is only of the most trifling character. Repeat medicine.
Cured.
CASE IV.-Simple Gonorrltaa, cured in its initial stage.
July 29th.- -      Coition four days since. There is tickling at the
orifice of the urethra, and a slight discharge just commencing.



44


CASES.


A few months later, he contracted a similar attack, treated it in
the same way, and got well in a week; and on a third occasion of a
like kind he was equally fortunate. His attacks are mild. In such
cases, the use of injections sometimes answers. As a rule, I have
found them fail, and in some cases they increase the irritation.
CASE VIII.-Simple Gonorrhoea, cred by Cannabis and Injection.
January 8th.- -, set. 29. Has had gonorrhoea ten days. There
is simply yellow discharge, without irritation of any kind. To take
Tinct. Cannabis, 0, gtt. x, ter die.
24th.-The discharge ceased after four days, and continued so for
a week; three days since it returned slightly. To use Lotio Plumbi
twice a day.
February 28th.-Has been quite well up to this time.
CASE IX.-Simple Gonorrhoea.
March 19th.-   -, aet. 30. Coitus nine days ago; discharge
appeared six days ago. He had rheumatism following a former
attack three years ago. He had, also, inflammation of the testicle,
after using a strong injection. There is, now, a copious yellow discharge, with cutting in passing water. He has had three bottles of
Balsam of Copaiba mixture, which has in no way controlled the
disease.
To have Aconite and Mercurius of the third decimal, alternately,
every four hours.
22nd.-The same, or nearly so. Tinct. Cannabis sat. 0, gtt. x,
ter die.
28th.- Considerable improvement; less discharge, and less
scalding. Continue.
April 5th.-Still some discharge, no scalding. Continue, and inject
Lotio Plumbi every night;
12th.-Wonderfully better. There is no discharge.
This case illustrates the evil of strong irritating injections used too early, and their benefit when employed after inflammatory symptoms have been subdued.



CASES.


CASE X.-Gonorrkcea-Failure of      njections in first stage-Cured
by Cannabis and Injections later.
February 10th.-Had intercourse nine days since. Two nights
ago, on going to bed, had a shivering fit, and in the morning a slight
milky discharge appeared. It continues much the same, with a
tingling after passing water, at the end of the urethra.
To take Aconite x, and Merc. corrosivus x, pilules, alternately
every four hours, and use injection of Liq. Plinbi two or three
times a day.
17th.-The injection did no good, but caused much irritation, and
he left it off after the second day. There is now copious yellow discharge; not much irritation. Take Tinct. Cannabis 0, gtt. xv, ter die.
24th.-Very great amendment. There is but little discharge;
no irritation. Continue medicine.
March 3rd.-Still less discharge; no irritation. Continue, and
use same injection as formerly, every night.
10th.-Scarcely any discharge at all. Continue. He had one
more repetition of the medicine, and was well.
CASE XI.-Acute Gonorrhola, with Irritation of the Bladder.
May 6th.- -, at. 23. Has had gonorrhcea a fortnight, and
has been under allopathic treatment all the time. The remedies
have purged him severely, and reduced his strength so much that
he can stand it no longer. Yesterday his medical attendant ordered
eight leeches to be applied over the pubes, for irritation of the
bladder, which has existed three days. There is heat in the bladder,
almost incessant urging to pass water, and scalding all along the
urethra. The discharge is copious and yellow.
Take Aconite -, and Canth. -, alternately, every four hours.
15th.-Was better two or three days. Again pain at the end of
the urethra, and frequent desire to micturate. Continue medicines.
23rd.-Very much better indeed. No pain. The bladder entirely
relieved. Discharge less in quantity. Take Cannabis sat. q, gtt. x,
ter die.



CASES.


31st.-Still some discharge.    No irritation.  Continue to use
Injectio Plumbi, om. nocte. He continued the injection a few days
longer, and took, at last, Tinct. Sulphur, and was quite well.
CASE XII.-Acute Gonorrhiea, complicated wOith        Irritation of
Bladder and Erysipelas of Penis, and slight Stricture.
July 1st.- -, et. 41. Has had gonorrhea three days; slight
milky discharge, with irritation of the end of urethra.
Take Aconite k, and Mercurius corrosivus ', alternately, every six
hours.
4th.-A good deal of scalding, more copious discharge, mixed
with a little blood; there is also frequent desire to pass water.
Take Aconite and Cantharis, each the third decimal, a drop,
alternately, every six hours.
13th.-Amelioration of most of the symptoms.
Take Tinct. Cannabis 0, gtt. x three times a day.
18th.-Violent headache, quick     pulse, chills, feverish.  The
discharge much the same, and the prepuce and body of the penis
attacked with erysipelas. The whole organ is enormously swollen,
and intensely red.
Take Belladonna tinct. k, and Aconite ', alternately, every four
hours, and apply cold-water cloths to the penis.
22nd.-The erysipelas subsiding. Better in health. Discharge
-and scalding less, but he has frequent watery diarrhoea.
Take Veratrum x, every four hours.
25th.-Well of the diarrhoea, and altogether better. Still a free
discharge, but very little irritation. Resume Tinct. Cannabis, and
use Lotio Plumbi injection every night.
From this date, chiefly with these remedies, he gradually improved.
The discharge was reduced to the smallest quantity, yet in that small
quantity it persisted, at one time being yellowish, at another
colourless. The stream of urine was a little contracted and twisted.
Suspecting slight stricture, I introduced a No. 6 bougie. There was
considerable obstruction. Neither this bougie nor a smaller one
would pass, the first time.   At the second attempt it entered
the bladder, and in two or three times more he was perfectly well.



CASES.


47


CASE XIII.-Acute Gonorrhoka-Orclitis-Allopathic treatmentCured by Aco., Canth., and Pulsatilla.
June 14th.-   -aet. 22. Has had gonorrhea ten days, and
under allopathic treatment all the time, taking Mag. carb. and
Sulph., and Vin. Ant., Pot. tart., with no good effect. There is
now a copious, thick, greenish-yellow, discharge, with pain about
midway up the urethra after passing water, and irritation of
the bladder, and occasional chordee.
To have Tinct. of Aconite, and ditto of Cantharis; a drop of each
of the third attenuation, alternately, six hours apart.
21st.-Nearly all the above symptoms have disappeared.       No
irritation of urethra and bladder, no chordee, the discharge much
less and not so green.
To have Tinct. Copaiba x, gtt. xv, ter die.
July 5th.-By report from the country, he has been undergoing
much exertion, and drinking freely of beer, and the discharge and
scalding have returned.
To have, first, for three days, Aconite and Cantlharis as before,
and then Cannabis sativa 0, gtt. x, ter die.
9th.-By report, laid up with inflamed testicle, much swollen, red,
very painful.
To have Tinct. Aconite X, and Tinct. Puls., two drops of each,
alternately, at four hours intervals.
16th.-No pain in testis; able to get up; a very little discharge.
Continue the medicines, with which he entirely recovered in the
course of a week.
CASE XIV.-Gonorrlhoa, with Inflammation of the Testicle.
November 12th.-    -     Has had gonorrhoea six weeks, rather
severely. He has taken Balsamn of Copaiba, and, latterly, saline
aperients. There is copious yellow discharge, not much scalding.
Take Cannabis sat. <, gtt. xv, ter die.
16th.-Much the same. Continue.
21st.-Nearly well. No discharge yesterday; a little moisture
to-day.,No inflammation. Continue medicine.



48


CASES.


28th.-Pain and swelling of the left testicle came on two days
since.
To have Aconite -, gtt. ij, and Puls. x, gtt. ij, alternately, 4tis horis.
30th.-Testicle much swollen, but easier. The discharge has
returned slightly.
To enter the London Homocopathic Hospital, where the same
treatment was continued under my own care. He recovered completely, in a few days, from the orchitis. The discharge, which continued in a slight degree after he quitted the hospital, was cured
by Liq. Plumbi injection.
CASE XV.-Gonorrhoea, with Inflamed Testicle.
This patient had gonorrhoea five weeks; was under allopathic
treatment. On the 21st of August I saw him, with inflamed testis.
He had then been confined to bed four days, and had been treated
rather severely with Calomel purgatives, lotions, &c. The organ was
very much swollen, hard, and tender; the pain extended up the cord
to the abdomen and loin; he was sick and feverish and thirsty. I
gave him Aconite X, and Pulsatilla x, alternately, every four hours.
The discharge ceased with the accession of orchitis.
Amendment set in immediately with the commencement of the
treatment, and on the third day he was able to get up. No alteration
of treatment was required, and he rapidly recovered. The discharge
returned in a slight degree, and was checked by Cannabis and Mercurius corrosivus; and lastly, an injection of Liq. -Plumbi in aqua.
CASE XVI.-Gonorrhlea-Warts at the Anus.
May 16th.---, at. 19. Applied to me a fortnight since for
wnat appeared to be an attack of low gastric fever. He had languor,
headache, loss of appetite, foul tongue, looseness of the bowels, &c.
He was compelled to relinquish his occupation and remain at home.
The treatment I adopted failing to relieve the above symptoms, the
suspicion arose that something undivulged by him, was keeping up
the stomachic irritation. It then appeared that he had had gonorrhcea two months, for which he had been taking large quantities of
Copaiba and other medicines, which he still continued to take;



CASES.


with no other effect than to disturb his general health. There is
still considerable discharge, though but little pain.
To take Cannabis. 0, gtt. x, ter die.
20th.-Very much better in health. The discharge less copious.
Continue medicine, and use injection twice a day of Lotio Plumbi.
29th.-Scarcely any discharge. He has passed blood, and suffered great pain, at stool, the last week or ten days. On examination,
a luxuriant crop of warts is found encircling the anus. I snip these
off, and apply dry lint, and give Thuja c, gtt. v, ter die, with
which, and a continuance of the injection for a few days longer, he
perfectly recovered.
CASE XVI1.-Spuriozs Gonorrhcea in an irritable subject, with
Prostatitis, and Orchitis, and Irritation of Rectum.
This gentleman had been under care some time for chronic
prostatitis. There had been irritation of the bladder, too frequent
desire to pass water, and the discharge, from time to time, of transparent mucus.    These symptoms had been much benefited by
Aconite, Cantharis, Mere., Sldphur, and other remedies. At length
it was thought desirable to pass a bougie. This was done, with but
very slight obstruction, and very considerable relief to the above
symptoms: more decided relief, indeed, than had been obtained by any
other treatment. Suddenly, after the bougie had been introduced
about six or eight times, violent irritation ensued. All the symptoms
of fresh genuine gonorrhoea were set up-copious milky discharge,
intense inflammation of the orifice of the urethra, scalding. The irritation extended along the urethra to the bladder; there was constant and painful urging to pass water, with the discharge of blood.
To this succeeded inflammation of the prostate, marked by pain, at
first sharp, and subsequently heavy, and aching, in the perinmum,
with great tenderness on pressure over the gland, and inability to sit
or stand; there was, also, partial retention of urine. This state of
things lasted for some time, and during its progress one of the testes
became inflamed, painful, and very large. The rectum was the next
and last part affected. There was constant urging to stool, great pain
4



52


CASES.


little discharge indeed. Again bougie; less obstruction. Continuemedicine.
18th.-Very little discharge. Treatment the same. This was
repeated two or three times more, and he had no further annoyance.
CASE XX.-Stricture, withi Fistulous Openings in the Perincaum.
A gentleman, et. 40. Had gonorrhoea several years since, of an
acute nature. Had for a long time been troubled with his water,
being unable to pass it except in the smallest stream. He had undergone a good deal of treatment by different medical men, with
only temporary relief. The symptoms increased; he passed water
only in driblets, after much straining. Abscesses formed on the
perinmum, and fistulous openings remained, through which the urine
escaped. There was the most frightful irritation of the bladder, incessant desire to micturate, and the discharge of highly ammoniacal,
muco-purulent urine. His health was completely broken by pain and
want of rest; any attempt to pass a catheter in his then condition
was attended with the greatest agony. To have Aconite and Cantharis, alternately, every four or six hours. These medicines formed
the base of the treatment. He had from time to time Sulphur and
Nux; and Belladonna for one or two attacks of erysipelas in the
perinmum, which was caused by the irritation of the urine, escaping
through the false opening. The irritation of the bladder was
speedily allayed by the remedies; the urethra became tolerant of the
catheter. After several cautious, but fruitless, attempts, a passage
into the bladder was effected. This advantage was maintained; the
stricture yielded entirely,-the openings in the perinmum closed, the
urine passed the natural way, the patient's health became perfectly
restored, and has remained good ever since, now a space of six.
years.



05 6


PRIMARY SYPHILIS.


white, and sharp, and subsequently, when the healing
process commences, they become rounded, and red. The
bases of these ulcers are commonly covered with a lardylooking substance. They discharge, freely, rather a thin,
ichorous fluid, or yellow matter. The parts surrounding the ulcer are sometimes inflamed, but seldom much
thickened.
The soft chancre engenders suppurating bubo, but:seldom, if ever, infects the constitution.
HARD CHANCRE is not commonly distinguishable from
the soft chancre for the first twenty-four or forty-eight
hours. The change into its characteristic hardness is
gradual, and manifests itself about the third day, or a
little later. The hardness, when specific, cannot be mistaken.   The soft chancre sometimes becomes slightly
indurated, but it is very different from the hardness of
the true Hunterian chancre, which, when passed between
the finger and thumb, feels like a piece of cartilage. The
hardness seems to depend on plastic deposit into the
tissues surrounding the ulcer. It remains during the
whole course of the disease, and for some time after.
The shape of the hard ulcer'differs greatly from that
of the soft..   Its edges are seldom raised above the
surface, but commence abruptly, and pass in a shelving,
sloping, direction to the bottom of the ulcer, which dips
down deeply into the subjacent textures, and thus acquires
its well known, contracted, cup shape. The surface of



PRIMARY SYPHILIS.


57


the ulcer, instead of looking moist, and discharging freely,
like the soft chancre, is generally dry, or covered with a
kind of scab.
Hard chancre is frequently attended with induration
of the inguinal glands, which feel like a row of flattened peas under the skin; but they seldom suppurate.
This kind of chancre is the parent of the much dreaded
secondary symptoms. But few cases of this disease pass
off entirely without being succeeded, sooner or later, by
some manifestation, more or less severe, of this constitutional taint.
There is a form of ulcer, intermediate between the soft
and the distinctly hard chancre, called the elevated ulcer.
It is generally raised considerably above the surrounding
surface, almost like a large wart, the mass being formed
by thickened and somewhat hardened integument. Considerable inflammation of the contiguous parts accompanies this form of chancre. It is slow to heal. Though
differing considerably, in form and appearance, from the
true Hunterian chancre, it partakes of its nature, inasmuch as it is very apt to be succeeded by secondary
diseases.
PHAGEDJENA-DESTRUCTIVE ULCERATION-is less a
separate form of chancre, than a condition supervening
upon other chancres during their course.       The soft
chancre is more liable than the hard to become phagedaenic,
and the change is generally due to bad health at the time



58


PRIMARY SYPHILIS.


of infection, or to some unfavorable circumstances occurring during the progress of the disease. About a year
ago I had a case under care, which will be found detailed.
in a subsequent page, in which, after the ulcer had nearly
healed, the disease suddenly took an unfavorable turn,
broke out afresh at the root of the penis, and threatened
the entire destruction of the genital organs. The only
cause I could assign for this change, was the acute mental
anxiety the patient suffered, from fear of the nature of
his malady being detected by his family. This destructive
form of the disease is not frequently met with in private
practice, and amongst respectable patients; but it is not
uncommon in hospitals, amongst prostitutes and men
inhabiting close, unhealthy localities, and who lead irregular and intemperate lives. I am   persuaded, however,
judging from the rarity of phagedmna in homoeopathic
practice, and from what I know of the effects of large
quantities of mercury, that this medicine, administered as
it is administered by allopathic surgeons, is one of the
most prolific exciting causes of phagedsenic ulceration.
The depressing influences above alluded to, and a scrofulous constitution, are-the chief predisposing causes.
The symptoms of phagedaena vary so much in different
cases, that it would be difficult to give such a description
of them as should embrace all its phases. Its leading
characteristics are-the irregular shape of the ulcer; its
jagged and irritable edges; its angry appearance; its
painfulness; the thin, ichorous discharge that comes from
it; and, its tendency to rapid and persistent extension.



PRIMARY SYPHILIS.


59


In spite of all that can be done to arrest its progress, it
will sometimes continue to spread until large portions of
the genital tissues are disorganized. Some time since
a case of this kind was brought to me by a provincial
colleague, in which the whole of the foreskin, and a considerable portion of the glans penis, was already destroyed,
and still the ulcer was spreading; and I recollect seeing a
case many years since, in which one testicle was entirely
denuded of its scrotal covering, by an ulcer of this kind.
URETHRAL CHANCRE, is simply an ulcer situated at the
orifice, or within the canal, of the urethra. This form of the
disease is chiefly interesting, on account of the light it
sheds upon a disputed point connected with the supposed
appearance of secondary symptoms after gonorrhoea.
Patients who were never known to have had primary
syphilis, but who had slight discharges from the urethra,
were affected with secondary symptoms. This discharge
was supposed to originate in gonorrhoea, the secondary
symptoms were attributed to it, and the inference was
drawn from the two circumstances, that syphilis and
gonorrhoea were one and the same disease. The error
is explained, by the detection of urethral chancre.
I have now under care a case of tertiary node of the
ulna, in a gentleman who has also had secondary eruptions, but who was never known to have chancre. He
had, however, many years ago, a slight discharge from
the urethra, which, being regarded as a clap, was treated



-60


PRIMARY SYPHILIS.


with Copaiba and injections. This was, doubtless, urethral chancre.    Such cases suggest the propriety of
examining the urethra when cases of slight discharge of
thick, yellow, pus from that passage come under the
surgeon's notice. The gonorrhoeal discharge is thinner,
milky, and more copious, even in mild cases, than that
from an ulcer. There is no fear of such an error in
diagnosis in acute gonorrhaea.
These ulcers are found just within the urethra, at a
very short distance from the orifice. They are generally
flat and superficial, and nearly of the same colour as the
mucous lining of the canal. Whilst little disposed to
spread or become hard, they are yet slow in healing,
owing, probably, to the passage of urine over them, and
to the constant contact of the opposing surfaces. This
contact may be obviated, in the treatment, by the insertion of a small piece of cotton wool, carrying Calendula,
or other, lotion.
Urethral chancres are said to be occasionally situated
higher up the passage. This I should think an exceedingly rare occurrence.    It is not easy to understand
how the virus could _be conveyed thither, nor how, except
by inoculation with the discharge, the existence of the
disease could be verified.
Treatment of Primary Syphilis.-We have now         to
consider the treatment of primary syphilis.
The object to be had in view is to heal the ulcer
before the system has become contaminated. To this



PRIMAIRY SYPHILIS.


by the old and the new school of practitioners, the difference consisting mainly in the dose, and this is an allimportant difference. The old plan is-mercury to salivation. Now, on the very threshold of this matter we
encounter a notable inconsistency in the teachings of
allopathic writers. Mr. Druit, who in his 'Vade Mecum'
may be regarded as expressing the general opinion of
the body to which he belongs, says, " Not that this," that
is, salivation, "is of any use, except to show that the
system is affected; because," he continues, "the action
of the mercury must be kept up until the ulcer heals,
and all hardness in the part disappears." This is not
only inconsistent, it is purely absurd. If the healing
of the ulcer, and the disappearance of the hardness, be
the true test of cure, on what conceivable ground is it
laid down as a law, that mercury must be given until the
mouth is made sore? Of two things let us have one. If
salivation be the standard, adhere to it; if the healing of
the sore, and the absence of hardness, then hold by them.
If the disease be cured, why, in the name of all that is
reasonable, should the unhappy patient be doomed to
salivation, which, according to Mr. Druit's own confession, is useless, except to show that "the system is
affected?"  The system affected! Herein lies the whole
fallacy. It is assumed that the sore will not heal, nor
the hardness subside, unless the system     is affected.
Strange, that it should never have entered into the heads
of our learned brethren to test this point-to try whether
the disease might not be cured without affecting the



PRIMARY SYPHILIS.


63


system! There is no fact in science better established
than this, that syphilis may be as thoroughly, as quickly,
and as effectually cured by mercury in doses short of
salivation, as by mercury in those poisonous doses which
"affect the system."  This, from Hahnemann's time up
to the present, has been proved, over and over again, in
thousands of cases, in the practice of homceopathic surgeons. I, myself, during the last sixteen years, have
treated more cases of syphilis, in all its forms, homoeopathically, and have made better cures, than I did during
the previous fourteen years of my allopathic practice.
The whole question admits of demonstration. There is no
mistake about the disease. It is open to our view. The
progress of the cure, and the result, are equally patent.
There is here no room for cavil. Whatever arguments
may be made use of to explain away the effects of
homeopathic remedies in other diseases, are here totally
inadmissible. Time, nature, and imagination, which, in
the opinion of our opponents, come so generously to the
rescue of the homoeopath in other cases, will hardly be
invoked in a case of chancre, even by our bitterest opponent. A chancre is a fact, and a stubborn fact, too,
unless it is well treated.  Homoeopathic patients, unfortunately, enjoy no exemption from these facts; and if
our doses of mercury do not cure them, then we may
fairly ask to what agency their cure is due; for, that they
do get well, no one will dispute; and the patients themselves shall be our judges, whether or not they have been
subjected to such doses of mercury as affect the system.



64,


PRIMARY SYPHILIS.


Admitting, then, that syphilis is curable by innocent doses of mercury, the force of such an admission,
in modifying the ordinary mode of treating the disease, is as apparent as it is irresistible.  Is any one
ignorant of the effects, present and prospective, of salivation? Are those effects not as familiar to our ears as
household words? and their associations, are they not
those of long-suffering wretchedness? Is it nothing to.
be able to avoid all this? Is it not, rather, one of the
greatest boons that can be conferred upon erring humanity! This boon homceopathy does confer? and not
only so, it places us at an immense advantage in the
management of the disease. With allopathy it is a matter
of vital importance to the patient that the surgeon be
able to distinguish, at once, and with unerring certainty,
between a venereal and non-venereal sore, because, upon
this decision depends the question, whether he is or is not,
to be salivated. If non-venereal, he will be treated with
a cooling dose, and some bland lotion; if venereal, he must
have mercury. But it is sometimes very difficult, if not
impossible, to determine the true character of a sore. The
patient, here, cannot be allowed the benefit of the doubt.
If you err, err on the safe side, says the allopath. Better
salivate twenty innocent men, than let one guilty one
escape! But with the homoeopath the case is quite
different; he acts upon the simple law that "like cures
like." He knows that mercury cures ulcers on the skin,
and venereal ulcers amongst others, in virtue of its property to produce ulcers in healthy subjects; and, if a



PRIMARY SYPHILIS.


65


patient present himself to him with an ulcer on his
penis, I do not say that he is indifferent as to its nature,
but, whether he be able to determine this point or not,
whether the sore be venereal or non-venereal, he will
probably prescribe mercury, for the simple reason
that it is the right remedy.      It is, then, not only
unnecessary, it is in many cases positively injurious to
the progress of the cure, to affect the system with
mercury. Salivation, by inducing mercurial fever, irritates the ulcer, retards granulation, and tends towards
the production of that most destructive and much
dreaded form of the disease, the phagedsenic ulcer.
Upon the system its effects are equally deleterious; it
sets up general fever, destroys the appetite, and causes
diarrhoea, dysentery, and ulceration of the mouth and
throat.
As regards the indications for the use of this remedy,
whilst it is, certainly, most imperatively demanded in the
indurated ulcer, I considerit as suitable, at times, to all kinds
of chancres. Even in the phagedmenic, in which its use is
generally thought to be contra-indicated, I have known it
to arrest the ulceration when other remedies, ordinarily
recommended for that condition, have failed. In the old
school there is so much dread of the effects of mercury
that every opportunity is seized of avoiding its use, except
in the case of hard chancre, in which it is regarded as indispensable. I have already shown such apprehension to be
totally out of place in homoeopathic practice; and, on that
5



66


PRIMARY SYPHILIS.


account, as well as on account of its being beyond all others
the most efficacious of remedies, I do not hesitate, whenever a patient presents himself with a suspicious-looking
sore on his penis, to give mercury at once, if it has not
already been administered in large quantities.  There is
no doubt that some soft, superficial, ulcers will heal readily
enough under the action of other medicines, or even
-without any medicine at all, and that mercury is most
imperatively demanded in the indurated chancre; yet, I
have treated many cases of soft chancre without mercury,
in which,ultimately, I have been compelled to resort to that
medicine, either because the healing process did not commence, or because granulation, having proceeded to a
certain extent, came to a standstill. The conclusion,
therefore, at what I have arrived, after carefully testing,
and watching the effects of different remedies, is this
that the surgeon who relies most on the proper and
judicious use of mercury, will cure, expeditiously and
permanently, the largest number of chancres.
Then, as regards the form of the medicine, I am
decidedly of opinion that the black oxide of Hahnemannthe.Iferc. Sol.-is the best. In the primary chancre, I
seldom employ any other preparation, and it rarely fails
me. And as regards the quantity, I am    satisfied that a
considerable modification of the doses ordinarily recommended in    homoeopathic books, is requisite.    These
quantities I believe to be too small.     It must not
be lost sight of that, in treating syphilis, we have to



PRIMARY SYPHILIS.


ý67


d<eal, not with a disease consisting in simple functional
disturbance, or in structural alteration arising therefrom, such, for example, as takes place in common phlegmasia, but with a disease engendered, palpably, by the
local or constitutional operation of a virulent poison.
In the former case, a medicine in exceedingly small doses,
acting through the agency of the nervous force, is generally sufficient to rectify the diseased action. In the
latter, a poison has to be neutralised, and, to effect this,
the remedy requires to be administered in quantities,
which, though still very small, are considerably larger.
Careful observation has convinced me of this necessity,
and one or two striking illustrations of it will be found
amongst the cases of syphilis.
The dose which I commonly employ, and which I have
found very effectual, is two or three grains of the first or
second decimal dilution, repeated threetimes a day. I sometimes commence with the former, and continue it for a
week, or until amendment sets in, and then replace it by
the second dilution. More commonly, I give the latter
only, and resort to the first dilution chiefly in cases of
obstinate indurated chancre. There is one error against
which I must here caution the young homoeopathic
practitioner-that, I mean, of too hastily changing the
treatment. Let him persevere steadily in the use of a
well chosen remedy, and this perseverance will more
surely be crowned with success, than will that vacillating
impatience which leads him to vary the remedy with.every variation in the outward appearance of the disease.



68


PRIMARY SYPHILIS.


In no case does this apply more forcibly than in the
treatment of syphilis, and in the homoeopathic use of
mercury.
Other preparations of mercury, if the surgeon prefer
them, may be employed in the cure of chancre-the
Mlerc. viv., the Merc. corrosivus, the Proto- and BinIodides. The latter may be advantageously given to scrofulous patients, and in cases where the primary sore, and
secondary symptoms, coexist. But, on the whole, I conceive the iodides to be best suited to secondary and
tertiary syphilis. The triturations of these, as well as of
the black oxide, I regard as more certain in their operation
than the spirituous solutions; in which form, moreover,
the medicines cannot be administered in such low potencies, as in trituration.
Acidum nitricum.-This is another great syphilitic
remedy, second only to Mercury in its power of neutralising the effects of syphilitic virus.
In their dread of Mercury, the members of the old
school are ever casting about to find substitutes for that
medicine; and of these, Nitric acid has been lauded as
one of the most powerful. Now, according to the strict
application of the homeopathic law, no one medicine can
be, properly speaking, a substitute for another; and, in
the treatment of syphilis, so far from Nitric acid being a
substitute for Mercury, it has, like Mercury, its own peculiar sphere of action, which no other medicine can fill.
Thus, whilst Mercury is the proper remedy for chancre,
and particularly for hard chancre occurring in persons of



PINIMAItY SYPHILIS.


69


good constitution, who have not previously been poisoned
with Mercury, Nitric acid is as distinctly the proper
remedy for chancre, and particularly for soft chancre, in
persons of weak and debilitated.constitution, whether
that condition be the result of scrofula, or of the
noxious influence of Mercury, or of a previous venereal
taint.
This distinction being kept in view, it is at once
apparent, that we could as little spare the one medicine
as the other. Mercury is more frequently called for than
Nitric acid, simply because the class of cases to which it
is applicable are more numerous. Syphilis is most commonly contracted by the young, the ardent, and the
vigorous. But, on the other hand, the cases are by no
means few, in which the disease is contracted by those of
an opposite temperament; and more numerous still are
those cases which occur in persons whose constitutional
powers have been undermined by the combined influence
of Mercury and syphilis, in previous attacks. In these
cases, Acidum nitriczim is, generally speaking, the appropriate remedy.
As I have before remarked, venereal diseases, being
exceptional in their nature, require to be exceptionally
treated as regards the doses of some of the remedies.
Formerly, I was in the habit of administering, in these
cases, the minutest doses of Acid. nitric. The effect,
if not   altogether inappreciable, was, at least, very
uncertain and unsatisfactory. Latterly, I have prescribed



70


PRIMARY SYPHILIS.


it in doses of from five to ten drops of the second decimal]
dilution, with very decided advantage.
The alternate action of the two foregoing remediesMerccry and Nitric acid-when either of them, singly,
seems inoperative, is sometimes very useful. Thus, commencing the treatment with Mercrizus, the ulcer beginning to heal, has, at the end of ten days or a fortnight,
come to a standstill, or has retrograded. Acid. nitricum
has instantly restored the healing process; which yet,
again, after the lapse of a few days, has required the resumption of M-ercurius to complete the cure.
Other medicines are named in homceopathic books as
remedies for chancre, such as Arsenicum, Argentun
zitricum, Corallia rubra, Causticea, loditn, Staphysagria, Thuja, Sulphur, 4#c. I can quite understand that
Arsenicum might be useful in some forms of phagedena;
lodiium in scrofulous subjects; Thuja in condylomatous
growths; Sulphur as an intermediate remedy; and Argentum nitricum, we know, is useful as an external application. But I should certainly hesitate to trust to
either of these remedies in the treatment of hard chancre;
and even in soft chancre, I should feel greater confidence
in Mercurius and Acidum nitriczun. It is doubtless one of
the just boasts of homeopathy, that it has a rich repertorium, and is not confined to a single remedy in the treatment of any disorder. It should equally be the boast of
the medical man, to cure with the smallest possible number
of medicines.    His results are then more satisfac



PRIMAIRY SYPHILIS.


71


tory to himself, and his experience more useful to
others.
Local treatment of syphilis.-Much may be done in
this respect, to check ulceration and favour the granulating
process. When the ulcer is not placed beyond our reach
by a contracted foreskin, a piece of cotton-wool, soakedin cold water, or weak Calendula lotion, should be applied
to the part, and changed twice a day; and if, in consequence of phimosis, the chancre cannot be got at, the
foreskin should be well washed out, by means of a syringe,,
first with warm water, and then with Calendula lotion.
"When a patient is so situated that he cannot procure Calendula, the Lotio Nigra is a useful application; but when
it can be procured, the Calendula is greatly to be preferred.
I have seen sluggish ulcers stimulated into active and&
healthy granulation in the course of a few hours aftercommencing the use of this lotion. In phagedmnic ulcers,
it is of the utmost service in allaying irritation, soothing
pain, and checking the ulcerative process. A light touch
of Argqentmz nitricum, in its solid form, is also a useful
stimulant to sluggish ulcers.
BuBO: inflammation and enlargement of the inguinal
glands, which may end either in resolution or in suppuration. Bubo is said to be gonorrhoeal, or syphilitic.
In the former case, which is very rare, it is purely sympathetic; in the latter, which is very common, it depends
on absorption of the syphilitic virus from a chancre.



PRIIMARY SYPHILIS.


Gonorrhoeal bubo is commonly excited by exercise.
In first cases, in which the symptoms are apt to run
high, the patient should be cautioned to remain as quiet
as possible. Gonorrhoeal buboes very rarely suppurate,
and yield readily to rest, and the application of cold compresses, or cold bread-and-water poultices.   The most
appropriate medicines are Aconitum and M]fercurius.
The syphilitic bubo is a more important affair. It arises,
as I have just said, from the absorption of the virus from
the primary ulcer, and is greatly influenced in its character
and course, by the nature of the ulcer to which it owes
its origin. Thus, the soft, freely discharging chancre
begets the suppurating and sloughing bubo; the indurated
chancre is accompanied by indolent induration of one or
more of the inguinal glands, which seldom form into
matter. This further interesting conclusion has also been
arrived at, viz., that secondary symptoms rarely follow a
suppurating bubo, whilst the hardened glands that attend
upon hard chancre, indicate that the system [is already
contaminated with the syphilitic poison, and that other
secondary symptoms will almost inevitably follow.
The soft, non-infe6ting, syphilitic bubo, as a rule, is
not attended with great pain or inconvenience.      The
patient is generally able, from first to last, to keep about,
and occupy himself as usual. It is, moreover, exceedingly
prone, in spite of all our efforts to the contrary, to suppurate. Indeed, so commonly have I found this to be the
case, that, beyond the application of cold water, I now
rarely direct any treatment especially to it.  If it be



PRIMARY SYPHILIS.


73


not arrested by the treatment proper for the original
disease, I despair of arresting it by any other means.
It is better to leave it alone until it is nearly ripe
for opening, then to apply a linseed-meal poultice for
a few hours, and evacuate the matter with a lancet.
This should be effected at the earliest possible period.
The destruction of tissue is then inconsiderable, and the
wound made by the lancet is small and clean; and under
favorable circumstances, the whole affair is over in the
course of a few days. But, if the matter be allowed
to accumulate until it finds an escape for itself, or until
the skin is deeply and extensively implicated, then a
large, irregular wound is established, the cavity of the
abscess is exposed to the irritating influence of atmospheric air, and extensive sloughing is apt to ensue. In
ordinary cases, little more is afterwards required, than
the application first of a few linseed-meal poultices, and
then of cold water, or Caledula lotion dressings. In
other cases, occurring in scrofulous habits, and especially
if the opening has been too long delayed, the wound,
instead of healing kindly, becomes irritated and inflamed,
and the inflammation extending to contiguous parts,
fresh openings are formed, until at length the whole inguinal region is occupied by a series of unsightly holes,
and burrowing ulcers. This is the
PRAGEDIENIC BUBO, which is often so troublesome and
difficult to heal. It demands the most careful management, both local and constitutional. The former consists,
first, in the use of warm linseed poultices; and, secondly,



SECONDARY SYPHILIS.


75


severity, situation, and duration. They affect most commonlythe skin, the mucous lining of the mouth, the throat,
the nose, and the structures of the eye. They make
their appearance either whilst the primary sore is yet
open, or within the space of a few weeks, or months, after
it has healed. Although relapses of the same attack are
very common, the first infection-like the infection of
smallpox and measles-seems to render the system proof
against a fresh invasion of these symptoms, from any subsequent attack of primary syphilis.
These diseases are transmissible from one person to
another; from husband to wife; from parent to child.
I have recently seen examples of both these modes of
transmission. A young man had secondary symptoms;
was treated, and pronounced cured. He married three
months afterwards. His wife was delivered of a child,
which almost immediately developed secondary symptoms around the mouth and nose, the anus, and on the
seat. It lingered, wasted, and died. The mother was
not infected. I have at the present time under care, a
lady who has contracted secondary symptoms of the
most distinct and marked character from her htsband,
who was cured of chancre before he married, but in
whom secondary symptoms have since developed themselves. Men should never marry, after having had hard
chancre, until sufficient time has elapsed to test the
probability of their having secondary diseases. These
diseases may be communicated in other ways, also.
Some time ago, there was an interesting case at the



SECONDARY SYPHILIS.


77


practice of homoeopathy confirms the opinion; since it is
amply verified, that secondary symptoms occur after
homceopathic treatment, much less frequently, and in
much milder and more curable form, than after salivation.
Improper diet, especially indulgence in spirituous drinks,
during the treatment of the chancre, also operates as an
exciting cause. Insufficient treatment, and the consequent imperfect cure of the primary sore, is another
fertile source of secondary disorders. Treatment should,
in all cases, be continued until the last traces of hardness
in the cicatrix, have disappeared.
The diagnosis of the early secondary syphilitic diseases
is generally not a difficult matter. They are so well
marked and distinct, and the recent existence of a hard
chancre is, commonly, so easily to be ascertained, that the
surgeon can hardly fail in arriving at a correct conclusion
as to the real nature of these complaints.
The diagnosis of chronic secondary affections is much
more difficult. The history of the case is our best guide,
but thelength of time at which some of these disorders will
appear after infection, often envelops them in obscurity,
even when the fullest information is at our command.
But, it is sometimes impossible-I allude here to the
cases of women-having proper regard to the feelings of
the patient, to obtain the necessary information on which
to base an opinion. I have recently had some female
patients under care in the London Homoeopathic Hospital,
with whom this difficulty occurred, but about the specific
nature of whose complaints, I entertained the strongest



78


SECONDARY SYPHILIS.


suspicions. Next to a correct history of the case, the
obstinate persistency of the symptoms is one of the
strongest confirmatory signs. Almost any chronic disorder yields more readily than old-standing syphiloid
affections.  Frequent relapse, after apparent cure, is
another diagnostic sign of syphilis. The deep coppercolour of existing skin diseases, or of the stains left by
former attacks, as alsolthe nocturnal aggravation of bonepains, are characteristic of the same taint. One of the
female patients to whom I just now alluded, and who was
admitted for old standing tubercular ulcerations and
formations around the knee, had also copper-coloured
stains on the lower part of the leg, and nocturnal
pains along the shin-bones. The great attention which
has lately been paid to this class of diseases, has thrown
much light upon the subject, and has pretty clearly
established the fact, that many anomalous symptoms and
conditions of the system, which baffled diagnosis, owe
their origin to a syphilitic taint.
It is not my intention to enter into a lengthened and
minute description of the numerous forms which secondary
symptoms assume. Such a course would occupy a disproportionate amount of space, and for practical purposes
is, moreover, unnecessary. The constitutional taint, there
is reason to believe, is one and the same, in all the manifestations of syphilitic diseases; and modifications of
treatment are demanded, less by the variations in any
particular class of these diseases, than by the peculiarity
of the structure which they attack.



80


SECONDARY SYPHILIS.


disease be allowed to proceed, the neuralgia, which had
begun in the fifth pair, attacks the seventh, and produces
paralysis of the face; and if we were not guided by the
chain of preceding symptoms, we might easily ascribe the
whole mischief to rheumatism.     I have often treated
cases of this sort, and I almost always succeeded in curing
them  by iodide of Mercury.      I have even met with
instances where the seventh' pair was primarily attacked,
without any previous neuralgia. After all these symptoms, sub-sternal paifis come on, which latter Baglivi
looked upon as symptoms of latent syphilis; then circa-articular uneasiness, accompanied with great lassitude in the
limbs, just the same as happens before eruptive fevers.
These articular pains are not situated in the centre of the
joint, but all around it; they are fugacious and intermittent; they do not produce any swelling or redness
in the part, and are not augmented by pressure; they
are vague, erratic, and nocturnal, presenting the same characters as the cephalalgia mentioned above."
The skin, and the mucous membrane of the throat and
mouth, are the parts most frequently affected.      The
symptoms follow no regular course in their accession:
sometimes the throat, sometimes the skin, being the part
first attacked.
The secondary affections of the skin are very various,
and may be ranged under the following heads, viz.,
exanthematous, papular, vesicular, tubercular, pustular,
squamous, and ulcerative.
THE EXANTHEM is one of the earliest of skin diseases.



SECONDARY SYPHILIS.


It is at first rosy, subsequently copper-colour. It may
appear on different parts of the body in succession, or
over nearly the whole surface at once. The face and
forehead, the arms, chest, and abdomen, are the parts in
which it commonly makes its appearance. It assumes
the form of flat, even, discoloration of the skin, and hasbeen mistaken for measles, to which it bears, in itsearliest stage, a considerable resemblance.
PAPULTM or PIMPLES, are another earlyform of secondary
eruption. The most common is that, the top of which,
after a few days, becomes covered with a fine scurf.
These pimples may be pale, or red, or of a darker colourstill. On the lower extremities they are apt to be broad,
flat, and of a deep copper-colour. The absence of itching
in these pimples is said, by some authors, to distinguishl
them from other pimples which are non-venereal, and are
generally attended with much itching. I have noticed
many exceptions to this rule, which is by no means
general, and, if too much relied on, is apt to mislead.
These pimples in some cases enlarge into circular patches
or rings, the whole being covered with fine scales, constituting psoriasis. This form of the complaint, when it
attacks the palms of the hands, is one of the most intractable of secondary eruptions.
PUSTuTLAE AFECTIONS are amongst the later and more
aggravated of the syphilitic skin diseases. They occur
in debilitated and broken down constitutions, and are
not uncommon accompaniments of that terrible condition known by the name of syphilitic cackexia. One of
6



SECONDARY SYPHILIS.


the most inveterate and obstinate of its manifestations,
is that which results in the formation of the hard lamellated scab called ru2lia.
ULCERATIONS of the skin, differing from those which
result from the rupture of the pustules we have just
named, or from the suppuration of tubercles, are amongst
the most obscure and anomalous of secondary symptoms.
Yet, there is often little or no doubt as to their syphilitic origin. A very remarkable case of this kind was,
admitted into the London Homceopathic Hospital about
a year since. The man was covered from head to foot
with hundreds of superficial ulcers, which clearly owed
their origin to syphilitic taint.
TUBERcLES comprise abnormal growths, in which the
diseased skin is raised abruptly in the shape of warts, or
in a rounded, hemispherical, form   above the surface;
also, flat elevations of the mucous membrane of the
tongue, velum, corners of the mouth, &c., and lumps
under the skin of different parts of the body.
Lastly, AFFECTIONS or THE SCALP, scurfs, impetiginous eruptions, falling off of the hair, &c., must be
mentioned, in this brief notice of the secondary diseases
of the surface of the body.
IF-LAMMATION and ulceration of the mucous lining of
the throat and mouth, are amongst the earliest signs of
syphilitic taint.  This affection makes its appearance
either early and by itself, or simultaneously with skin



SECONDARY SYPHILIS.


*85


manent cure. The truth, as in most other cases, lies
between extremes.    There is no doubt that in recent
cases of secondary disease, occurring in good constitutions, and where the system has not been saturated with
mercury, complete and permanent eradication of the
symptoms may be safely prognosticated. On the other
hand, it is equally certain that, when the taint has
once entered the circulation of persons of depraved,
scrofulous, and broken-down constitutions, it may but
too confidently be predicted, that, though secondary
symptoms may, for a time, appear to be successfully combated, relapses will occur with more or less virulence for
many years, and, possibly, for the remainder of the
patient's life.
The treatment. in former times, of primary syphilis
with destructive doses of mercury, by inducing the very
state of system I have just described, had much to do
with the development of secondary diseases in their
most inveterate and intractable forms. Modern science,
better instructed, obviates much of this mischief, by
avoiding the use of mercury altogether in treating some
cases of primary ulcer, and by giving it in more moderate
quantities, when it is employed. Still, I am convinced
there is room for yet greater improvement, and that
homoeopathy points out the way to it; and, to this important point we now proceed to direct our attention.
Secondary syphilis consists in the introduction of a
poison into the blood; and the cure of it, in the neutralization or eradication of that poison.



86


SECONDARY SYPHILIS.


The attainment of this object must be sought in the
careful, judicious, and prolonged use of medicines; and in
the adoption of such measures, hygienic and dietetic, as
are best calculated to sustain the patient's constitutional
powers.
First, then, as regards medicines. It is beyond a
question that, as with the original sore, so with many
of the constitutional symptoms which result from       it,
Mercury is one of the most efficacious remedies. We
constantly meet with cases in which the primary and
the secondary diseases coexist, and in which the Mercury
given for the one, cures the other at the same time.
Several examples of this are reported further on. There
is commonly in these instances this advantage, viz., that
Mercury has not previously been administered, and it is
precisely in such cases that the curative action of that
medicine is most decided. The same thing holds good with
reference to the secondary symptoms. If Mercuryhas been
given to any considerable extent for the cure of the
chancre, the benefit to be derived from its administration
in the treatment of secondary symptoms will be much
less marked, than in those cases in which it has been
given in very minute quantities, or not at all. In either
of the latter instances, unless there exist some special
circumstance to forbid its use, Mercury is often of the
utmost value in combating the earlier secondary diseases
of the skin: the erythema, papules, and squamae. Over
the more inveterate eruptions, it has, comparatively, but
little power. When, therefore, a well-marked and un



SECONDAIRY SYPHILIS.


87


doubted case of secondary eruption presents itself, following closely, or at no great distance upon the primary
disease, and in which the patient has not been mercurialized, it is well to commence the treatment with one of
the lower dilutions of the iodide or bin-iodide of Mercury
-the second or third decimal, in two-grain doses, twice a
day.   This should be steadily persisted in until the
eruption has vanished, or until it appears certain that the
medicine has effected all the good that can reasonably
be looked for from it. In many constitutions, these eruptive disorders are remarkably obstinate, and no remedy
will exercise a sudden influence over them. The BMercury
having had a fair trial, if it fail in effecting a complete
cure, another medicine must be resorted to, and the
Kalcci hJdriodicum claims our next attention. This is
a remedy of undoubted power in treating the secondary
diseases of syphilis; and in the majority of cases of skin
affections, as well as affections of other tissues, its aid is
required in expediting or completing the cure.        In
obstinate cases, especially those occurring in scrofulous
constitutions-and they are the most obstinate-it is a
good plan to give this medicine alternately with the
bin-iodide of Mercury, not in alternate doses, but during
alternate weeks, i. e., the Kali itydriodicUm  one week,
the lMercurius bin-iodidus the next, and so on. Excellent
results will often spring from the alternate action of
these and other remedies; and the more so, the less
rapid the alternations. To obtain its full curative action
in syphilitic diseases, the Kali liydriodiczum, like the



^8


SECONDARY SYPHILIS.


preparations of Mercury must not be administered in
too small doses. I am in the habit of giving two grains
of the salt three times a day, or three grains twice a
day, in aqueous solution. The principal indications for
its use are-a scrofulous and debilitated constitution;
enlarged glands in the groin, the throat, or neck; the
previous exhibition of Mercury in excess, marked by red:and inflamed gums, sore throat, foul breath, nocturnal
bone-pains.
Iodium-preparations of the simple metal-may be
used with advantage, in the quantity of five drops of the
second decimal tincture, in water, three times a day.
But on the whole, the compounds of Iodine, Mercury, and
Potash, are to be preferred.
Acitdum nitriczw  is another medicine which has long
enjoyed a wide-spread reputation in the cure of secondary
symptoms. My own experience has not inspired me
with unbounded confidence in its powers, in the early
secondary eruptions. Like Kali hydriodicum, it is distinctly indicated in cases where patients suffer from the
effects of over doses of Mercury. It is an excellent antidote to that metal; but as, under homceopathic treatment,
these cases of poisoning do not occur, and when homceopathy shall become the sole system of medicine, they
will cease altogether, the question arises, what, under
such circumstances, will be the proper sphere of Acidum
nitricum in the treatment of secondary syphilis?   It
appears to me that the grounds on which it is prescribed,
in the early skin eruptions, are somewhat slender. I



SECONDARY SYPHILIS.


89


have administered it in many cases, but the results, if
not equivocal, have been by no means striking, nor to be
'compared with those obtained from the iodides of Mercury
and Potash.
Cases of ulceration of the mucous membrane of
the throat, mouth, and nose, appear to me to be the
most appropriate for the use of this medicine in the
early secondary diseases.    It is also strongly recommended in the treatment of Condclomata, such as spring
up on the penis, and about the anus. It should be administered in from five to ten drops of the second or
third decimal dilution, two or three times a day. Less
doses, if not inoperative, are less efficacious.
Treatment of the diseases of the mucous mnembrane.These diseases, as has already been suggested, are often
induced by exposure to cold. When so induced, if the
patient be at the time, or has recently been, affected with
syphilis, these cases acquire a peculiar character from
that circumstance-they become chronic, secrete copiously,
and the tonsillary glands may become much enlarged, and
deeply ulcerated. These attacks, though of a syphilitic
type, have their origin in catarrh, and their early arrest
may sometimes be effected by the usual remedies for
catarrhal sore-throat, viz., Aconite, Bell., Apis, and  liercurius corrosivus. After Aconite has been exhibited to
reduce any general febrile excitement, as well as to act on
the local disorder, Apis is often very efficacious, in drop
Zdoses of the third decimal tincture. If it fail, Bella



90


SECONDARY SYPHILIS.


donna, Lachesis, and JAercurius corrosivus may be had
recourse to.
In cases of inflammation, or ulceration, of the same
part, in company with other secondary symptoms-of the
skin, for example-if Mercury have not already been administered to excess, the iodide or bin-iodide of that
metal, in one grain doses of the second or third decimal,
should be administered twice a day. The throat will
often get well paripassu with the other symptoms; but
should the disease persist when these have vanished, the
treatment may be directed against it especially. Acidum
nitricun is here a useful remedy, and may be given internally, in five-drop doses of the second decimal tincture,
three times a day; and at the same a gargle, composed
of half a drachm of the pure acid in six ounces of water,
may be employed locally. This, though beneficial in some
cases, is far less efficacious than the Argentum nitricum.
This may be applied in its solid form when practicable,
or in solution, in the proportion of five grains to the
ounce of distilled water; the throat should be mopped
with this once or twice a day. I employ this medicine in
one of these forms in the majority of cases of syphilitic
sore throat, and the comfort derived from it is immense.
It is beyond dispute that some persons are more susceptible than others to constitutional syphilis.   It is
equally certain that the scrofulous constitution is that
which is most exposed to its attack. That being so, the
importance of attending to the general health of the
patient, during the course of secondary syphilis, is self



SECONDARY SYPHILIS.


91


evident. He should carefully observe all those measures
calculated to maintain his health in the finest possible
condition. In those early secondary diseases of which
we have been speaking-of the skin and throat-being, as
they commonly are, inflammatory and febrile, he should
indulge in alcoholic drinks very sparingly, or not at all,
at least in the earlier stages. He should live on plain,
good, nutritious, food. In keeping with this, as well as in
reference to the depression of the general powers which
commonly characterise constitutional syphilis, cod-liver
oil is an agent of first-rate importance. Possessing the
advantage of not being medicinal, and therefore not interfering with the action of medicines, I find it in many
cases more than a substitute for the renowned Sarsaparilla
-a medicine which, when there is no particular indication for other remedies, may be prescribed with the
greatest advantage.   A small quantity of cod-liver oil
is sufficient-a dessert-spoonful, taken every night at
bedtime. Larger quantities, taken at other periods of the
day, are apt to do more harm than good, by nauseating
the patient, and destroying his appetite. If the throat
or mouth be affected, he should strictly avoid smoking.
He should not overfatigue himself. For skin diseases he
should take a warm bath twice a week. He should clothe
himself judiciously, and carefully guard against the common causes of cold.
The following medicines may, also, be administered
with  manifest benefit, viz., Acid. Sulphlur., Borax,
Lachesis, Phosphorus, Hepar Su1phuris, and Sulphur.



92


TERTIARY SYMPTOMS OF SYPHILIS.
Certain products of the syphilitic taint, more inveterate
than those we have been considering, differing from them,
also, in their nature and situation, and commonly affecting
the system at a later period than the secondary symptoms,
have been named by iRicord, tertiary symptoms of syphilis.
These diseases are said, also, to have lost the property,
which the secondary symptoms retain, of infection. They
seldom appear earlier than six months after the primary
disease, often later still, and there is no certain immunity from them for many years afterwards. Patients
have been known to develope them at the end of ten,
twenty, or thirty years. Either as local diseases, or in
the form of syphilitic cachexia, these symptoms may affect
every organ and structure of the body. They are chiefly
the following, viz., affections of the bony structure, of
the skin and cellular tissue, of the testes, and of the
system at large, in the form of syphilitic cachexia. We
will devote a few words to each of these, in the above
order.
AFFECTIONS OF THE OSSEOUS SYSTEM.
PERIOSTITIS-OSTITIS-CA-IES-NEccosIs. -Periostitis
is the earliest and most common of these affections.



GUTMMATA.


93.


There may be simple inflammation without perceptible
thickening of the membrane; or there may be a deposit of
plastic lymph, resulting in the formation of nodes. The
long bones of the leg and forearm, and the flat bones of
the skull, are most frequently affected. The leading symptoms are, dull aching pains, generally worse at night; great
tenderness on pressing the diseased part; and some impediment to free motion. Gradual enlargement, and hardening of the swelling, and its conversion into bony
structure, are the changes which result in hard node.
In ostitis, the bony structure is inflamed.  This is a
common consequence of inflammation of the periosteum.
It is apt to terminate in the formation of abscess, which,
discharging, exposes the denuded bone, and caries or the
destruction of portions of the bone, is the result. When
this occurs in the skull, if both tables of the bone are
destroyed, death may follow from exposure of the membranes of the brain. These severe cases of bone disease
seldom occur, except in depraved and broken-down constitutions, and are generally attended with hectic, and
general failure of the vital powers.
GUTMMATA.
This affection consists in the formation of small, hard,
painless swellings under the skin of the scalp, neck, extremities, scrotum, and penis, and under the mucous membrane of the tongue. These tumours may either subside,



SYPHILITIC SAICOCELE.


or remain hard and moveable for a long time, and ultimately suppurate, and discharge, leaving deep, spreading,
troublesome ulcers. In the tongue they are sometimes
very annoying. The organ becomes hard and knotty,
either in one portion, or throughout its whole sufaceits free motions in chewing and speaking being greatly
impaired.   These lumps may be distinguished from
cancer, by the absence of the lancinating pains which
characterise that disease, and by the knots being more
diffused and superficial; whereas cancer is in one
lump, is stony hard, and implicates the whole thickness
of the tongue.
SYPHILITIC SARCOCELE.
This consists in a gradual, and often at first imperceptible, enlargement of one or both testicles. The function of the organs becomes impaired, the semen is altered
in quality and quantity, and the venereal appetite diminishes. The enlargement, after having existed a longer
or shorter time, may be succeeded by reabsorption of the
abnormal deposit, and a gradual wasting, and, in some
cases, entire disappearance of the testis.



95


SYPHILITIC CACHEXIA.
This is the most direful of all the consequences of
syphilis. Here the very fountains of life seem to be
poisoned. Every function is deranged; the nervous and
physical powers become exhausted; the countenance
becomes sallow, and the surface anmemic; the flesh flabby;
the body wastes; the limbs become weak and trembling;
the appetite fails; and continued nervous fever, night
sweats, and hectic, supervene. Conjoined with these symptoms are commonly found disease of the bones; tubercles,
ulcers, and inveterate skin eruptions; and death may
result from general anaemia, or from some internal organ,
previously predisposed to disease, becoming disorganized,
such as ulceration of the lungs or intestines. The circumstances which favour the development of this terrible
condition, are a scrofulous constitution, improper treatment of syphilis, mercurialization, exposure to cold and
damp, intemperance, bad living, and other causes tending
to undermine the vital powers.
Treatnent of tertiary symp tovmis.--Several modifications
of the rules laid down for the treatment of the early
secondary symptoms, are here required. The cure, as
might be expected from the inveterate nature of these
diseases, is both more uncertain and more protracted,
than in any of the forms of syphilis we have hitherto
mentioned.   Palliation and retardation in some cases,



96


SYPHILITIC CACHEXIA.


and in others such control over the disease as shall keep
it in a state of quiescence, and cause the least possible
amount of annoyance to the patient, is the utmost that
can be anticipated. A complete and permanent cure is,
unhappily, the result in only a small minority of cases..
But, doubtful as the prognosis in any case of this kind
must be, I think that homoeopathic medication holds out
a much more encouraging prospect of benefit to the
patient, than the means commonly adopted in the ordinary
system of treatment.
This advantage is due to the application of our remedies
in accordance with the homceopathic law of similarities;
to the greater number of remedies at our command; and
to the wider field of action which, as a consequence, is
opened up to us. It is not enough, especially in these
inveterate and deep-acting tertiary affections, to attempt
to grapple with all their phases by Iodide of Potassimn,
as is ordinarily done.  That is a most useful remedy in
many cases, but it is by no means of universal application.
On the very day on which this is written, I have seen
a case of tertiary disease of the tongue, which, under allopathic treatment, was always aggravated by Iodide of
Potassiun. The pliability-or rather the greater adaptability-of hommeopathy, leaves one at no loss for a remedy
in such a case.
From the very nature of the circumstances, it would
be impossible for me, advantageously, to do more than
give a bare enumeration of the chief remedies applicable
to the different classes of tertiary diseases. Each case, to



SYP31LITIC CACHEXTA.


97


be treated with any prospect of success, must be studied
by itself, in reference to its particular and appropriate
remedy. In simple and uncomplicated diseases, such as
the primary venereal affections, the symptoms of which
are comparatively few and constant, distinct rules of
treatment may be laid down. In affections so deep-seated,
so complicated, and involving so many organs and functions, as the secondary and tertiary affections, such a
course would be impossible. We can here only indicate,
not direct, the treatment.
For affections of the periosteum and bones, then, the
following remedies are the most useful, viz., Acid. nitric.,
Aurzim, Calcarea, Kali Hydriodicum, lodium, lifezereum,
iJfercurius, Phosphorus, Phosphoric acid, Silicea, Sulphur.
In affections of the testes, which often stand alone as
indications of syphilitic taint, reference must be had, also,
to the state of the constitution generally, and the treatment must be directed accordingly; and as scrofulous
degeneration is frequently a leading characteristic, the
remedies suitable to that condition would necessarily be
referred to. The following have a direct action on the
testes, viz., Aurwum, Conium, Clematis, lodium, ljercurius,
Pulsatilla, Phosphorus, Sulphur.
In syphilitic cachexia, the following are amongst the
most appropriate: Arsenicum, Acid. phosphor., Acid.
nitricum, Carb. vegetab., China, Kali Hydriodicum, lodium,
Mercurius, Sulphur.
Here again, as I have done before, when speaking of
the primary venereal diseases, I would venture to express
7



98


SYPHILITIC CACHEXIA.


a decided preference, based on careful observation, in
favour of more than ordinarily potent doses of the medicines. It should never be lost sight of that in syphilis,
and especially in its secondary and tertiary forms, we
have to deal with a virulent, destructive, and all-pervading poison, which, circulating in and contaminating
the blood, attacks the different organs, induces in them
structural alterations, interrupts their healthy function,
and so tends constantly to undermine the vital powers.
To rouse and sustain these powers, to neutralize the
depressing effects, if not to antidote the essence, of this
poison, I am convinced that, as a rule, the higher potencies of medicines are comparatively useless, and that
quantities, larger than the ordinary homoeopathic dose,
are essential. I am constantly meeting with cases-with
all respect to my professional brethren I say it-both of
primary and secondary syphilis, in which the small doses
have failed utterly, but which have improved, or got well,
under the action of the same, or no better chosen remedies, but which have simply been administered in Jarger
doses.
Here, also, I would repeat what has already been said
with reference to the importance of attending to the
general health of patients labouring under the constitutional effects of syphilis. It is not sufficient simply to
give an infinitesimal dose of medicine and say, " Be thou
clean." Collateral aid must be obtained from every agent
calculated to improve and sustain the patient's constitutional powers. These cases are almost always developed



SYPHILITIC CACHEXIA.


99


in scrofulous constitutions; or, if not, the diseases themselves have a tendency to depress the vital powers, and
induce all those feelings of languor and debility which
have already been described.     To counteract this, to
bring the system up to the finest standard of health,
and neutralize the effects of the venereal virus, the
patient should be instructed to adopt all those means
which are known to impart vigour to a depraved constitution. Foremost amongst these are temperate, yet
generous, and nutritious diet, cod-liver oil, friction of the
skin, and bathings, different kinds of out-of-door exercise,
and especially, when it can be obtained, country, and seaside, air. The effects of syphilis are much less severe in
the country than in towns. Above all, the patient should
be impressed with the absolute necessity of a steady and
prolonged perseverance in the proper course of medical
treatment. Nothing but this will bring about ultimate
immunity from the ravages of the venereal poison.



104


CASES.


12th.-The ulcer healing favorably. The buboes looking healthy
under Calendula dressing.
30th.-Quite well.
It is well known that the situation' of the ulcer determines that of the bubo. The latter is always on the
same side as the former.    In this case, an ulcer on both
sides of the fraenum, begat a bubo in both groins.
CASE IX.-Soft Chancre, with Phimosis and Bubo.
December 18th.- -    Five weeks a chancre at the junction of
prepuce and glans penis. The foreskin is so firmly contracted that
the ulcer cannot be seen. There is a red, inflamed bubo in one groin,
which has been coming forward the last week. He has been under
treatment, and is told that he has had no Mercury.
To take MXer. sol. I, gr. ij, ter die.
24th.-The penis is much better. The foreskin less swollen and
tender; no discharge. Open the bubo, and order him to continue
the same medicine.
January 1st.-The bubo doing well. The penis ditto.
15th.-The bubo healing under water dressing. The foreskin less
swollen and contracted. He can with some little difficulty retract
it, and the ulcer is found to have healed. From this time he dressed
the bubo with Calendula lotion, as it was rather sluggish in healing,
and recovered without any untoward symptom.
CASE X.-Bubo, after Soft Chancre.
December 18th.- -    Coition seven weeks since. There was a
superficial, ulcer-like excoriation on the outside of prepuce four weeks;
never any hardness. He applied Zinc lotion, but took no medicine.
There is now a scab firmly attached to the seat of ulcer. Eight
days ago, a gland in the right groin became tender and swollen.
There is now a bubo nearly ready to open.
Take Mer. sol. -, gr. ij, bis die.



106


CASES.


latter. The disease progressed under salivation.       The
Nitric Acid, which antidotes the Mercury, did not arrest
the ulcerative process, which still persisted under the
second allopathic course of Mercury, and was only arrested, and the cure brought to a successful issue, by the
small doses of the black oxide. Other cases of a like kind,
that have occurred in my own practice, confirm this
view of the case.
CASE XII.-Chancre-threatening Bubo-Warts.
May 3rd.- --  Six weeks since contracted chancre. Understanding something of medicine, he touched it himself with caustic. Then
took one-grain doses of Iodide of Mercury, which purged him. Then
rubbed Mercurial ointment into his thighs for a week. Then took
five-grain doses of Hydr. c. Cretd three times a day. All this
produced no perceptible effect on his system. The ulcer, after a
while, nearly closed, but there still remained, at the above date, some
hardness, and a tendency to warts, which are springing up near the
frmnum. Thinking he had had Mercury enough, I prescribed Acid.
Nitric. 5, gtt. x, ter die, and Calend. lotion to part.
21st.-The warts had nearly disappeared, but there was an open
ulcer-a fresh one-by the side of the franum preputii; a gland in
the groin was enlarged and tender.
To have lMer. sol. t, gr. ij, ter die.
June 6th.-The greatest amendment followed this treatment.
The gland in the groin was well, the warts had disappeared, the ulcer
had healed. Continue medicine a little longer. Cured.
This case was interesting as showing the good effect of
Acid. Nitric. in checking warty growth, and as proving
that the previous exhibition of Mercury in large quantities
does not always contra-indicate its use in homoeopathic



CASES.                          107
doses; nor apparently does it interfere with its curative
action.
CASE XIII.- Simple Sloughing Phigedanic Chancre, Sc.
October 12th.- -     Impure intercourse ten days since; an ulcer
appeared seven days after on the edge of the prepuce, and another
at the root of the penis; the former is soft and lardaceous, the
latter scabbed over.
To have Mere. sol. -, gr. ij, ter die.
15th.-The ulcer on prepuce already looks a little cleaner, and the
swelling and inflammation of prepuce less.
Mere. sol. i, ter die.
22nd.-The swelling of prepuce gone, the ulcer filling up. The
scab at the root of penis hard, but separating from the skin, as if
healing underneath.
November 19th.-The ulcer all but perfectly healed over. The
scab ditto. Continue medicine.
From that time, without assignable cause, the place at the base
of the penis became unhealthy; it spread rapidly, became foul and
sloughy at the bottom; gradually, another and another place
became hard, then black, sloughed, and left a deep, foul ulcer, until
at length, the whole root of the penis was encircled with these foul
ulcers, which threatened to amputate the organ, unless arrested in
their progress. Being satisfied that they were of the nature of soft
chancre, and having, therefore, no apprehension of secondary symptoms, I at once omitted the Mercurius and gave Acid. Nitric. -, ten
drops, every four hours. Nourishing diet and cod-liver oil. The
patient to remain quiet and recumbent, and to apply linseed-meal
poultices to the ulcers.  Under this treatment the destructive process was gradually arrested.  The healing process, however, being
very tardy, I again resumed the use of Mercurius in the form of
iodide,3 gr. ij, night and morning, still continuing the Acid. Nitric.
for some time longer in the middle of the day, and ultimately this
was changed for Kali hydriodicum. The patient's health improved,
(for he had become weak), the ulcers filled up, he resumed his occupation, and has suffered no inconvenience since.



108


CASES.


This was an interesting, though exceedingly severe and
obstinate, case. I could not account for the sudden
accession of unfavorable symptoms, except on the score
of intense mental anxiety, which the circumstances of
the case unavoidably entailed upon him.
CASE XIV.--   ard Chancres, and secondary Erythema, at the
same time.
July 12th.- -   Intercourse two months ago. One ulcer has existed five weeks. There are now two large, deep, foul, ulcers, eating
down into the glans penis just by the corona. The prepuce is much
swollen, and there is almost strangulating paraphimosis.  The
bases of the ulcers are very hard. There is scarcely any discharge.
He came to me a few days before the above date, complaining of
lassitude, headache, loss of appetite, &c., but said nothing about the
syphilis. Visiting me on the 12th, his body, from head to foot, was
studded, almost as thickly as confluent smallpox, with secondary
erythema. I at once saw its nature, and a single question and
answer, explained the whole state of the case. The eruption was
papular, and many of the spots were scaly. He still complained
of the constitutional symptoms which often accompany the outbreak
of these eruptions-headache, debility, anorexia, &c. He had also
some soreness of the throat and a slight husky cough. He had
undergone no treatment whatever for this complaint.  I drew the
foreskin forward, ordered Lotio nigra to be applied to the ulcers,
and gave him MJerc. sol. ~, gr. iij, ter die, to take internally.
18th.-Already amazingly better.   The ulcers look clean and
healthy, and are granulating. The eruption is fading fast. He is
also better in health. Continue the treatment.
August 2nd.-The chancres have filled up and healed over. Continue the MeP. sol.
14th.-The rash much less prominent. Some hardness in the
seat of the ulcers. He continued treatment for some time longer,
taking ultimately the iodide instead of the oxide of Mercury. He
got perfectly well, and has had no sign of a relapse.



CASES.                         109
Let those who question       the power of homoeopathic
remedies to cure syphilis, explain away this case, one of
the most genuine examples of primary and secondary
syphilis that could possibly come under a surgeon's notice.
CASE XV.-Hard Chancre and Secondary Symptoms.
February 10th.- --Ten weeks since contracted what he was
told by a medical gentleman whom he consulted in the country was
" an excoriation" on the corona glandis. It was then quite soft.
Ordered Black wash, but no medicine.    The ulcer did not heal.
Then, a fortnight from the first, it was burnt with caustic, and
twice afterwards, the last time three weeks ago.  There was no
hardness before the caustic was applied. There is now a large
chancre, as hard as a piece of leather, under the foreskin, and yet
his medical attendant still persists that it is not syphilitic, and declines giving him any medicine.
To take Mfer. sol. , gr. iij, ter die.
15th.-By report, the sore spreading and eating down into the
penis. Continue the medicine.
It should have been stated that when he visited me on the 10th
he had on the forehead and face, and other parts of the body, a great
deal of papular eruption, some of the spots being covered with fine
scurf. He had suffered some days previously with frontal headache,
and a sense of immense weight on the top of it; he had also aching
pains in his back.
22nd.-He visited me again, wonderfully better. The spots are
much fainter, and the ulcer has filled up and nearly skinned over.
Continue medicine.
March 20th.-Has continued the treatment for the last few
days with the second decimal instead of the first. The ulcer is
quite well; some hardness remains. The spots scarcely visible.
Jfere. biniodid. j gr. iij, bis die.
April 1st.-Apparently well; some faint stains of the skin. Continue treatment, for safety sake, some time longer.



110                          CASES.
CASE XVI.-Hard Chancre and Secondary Sore Throat.
December 18th.- --      t. 45. Has a small, hard chancre on the
tip of the penis, involving the whole of the orifice of the urethra.
The orifice is red and swollen, and covered with a hard kind of scab;
there is no discharge. When grasped between the finger and thumb
the part feels like a large pea in size and hardness.
Take Mere. sol. 1, gr. ij, ter die.
Under this treatment, with no variation, excepting that the
second decimal was substituted for the first, the ulcer gradually
cleaned, the leathery surface gave place to healthy granulations;
the hardness gradually subsided, and on the 18th of January the
wound had healed.     He continued the medicine for some time
longer. The glands in the groin were not enlarged, nor were there
any signs of secondary symptoms, until one cold day he incautiously
rode outside a cab without sufficient covering, and caught a severe
cold, which resulted, two days later, in a sore throat, and much
enlargement of the tonsils, which ulcerated at first superficially, and
then deeply, and gave a good deal of trouble for three months or
more. The tongue also, and the corners of the mouth, became inflamed and cracked.
He had Kali hydriodicum 0, gr. ij, his die; Mer. biniodid. -, gr.
iij, bis die; 01. Jecoris, and caustic to the throat. The patient persisted, throughout the whole attack, in smoking, which in all cases
of sore throat and affections of the tongue and mouth, is a most pernicious habit, and should be scrupulously avoided.
CASE XVII.-Hard Preputial and Urethral Chancres-Secondary
Symptoms.
August 22nd.- ----, t. 24. Had impure intercourse a month
since. The last week an ulcer, small, raised, and hard, on the frmnum.
To take Mler. sol. 1, ter die, and Calendula lotion to be applied to
the part.
28th.-The same. Continue.



CASES.


117


no opportunity of ascertaining the result of her accouchement-whether or not the child was infected.
CASE XXV.-Secondary Syphilitic Iritis.
October 19th.-  -, aet. 31. He had contracted chancre some
months previously, and was treated allopathically by large doses of
Mercury. It had been followed by secondary skin eruptions, and
these by iritis, for which he took Bell., Mere., and other remedies
prescribed by a colleague, and had Belladonna applied to the
brow. The active symptoms were a good deal subdued when he
visited me. The iris, however, was still irregular and discoloured, and
the sclerotic red and inflamed. There was some hardness and redness remaining on the site of the ulcer on the penis. There was
also, enlargement and superficial ulceration of the tonsils. His health
was not good. He had been living rather low, and was not of robust
constitution.
To take Tinct. Arsen. X, gtt. v, ter die, and Cod-liver oil, and
drop a solution of sulphate of Atropine into the eye every night.
23rd.-The change for the better was very great. There was
scarcely a tinge of redness on the eye remaining. Continue medicine.
28th.-The eye all but well. The throat much better, also. From
this time his amendment was uninterrupted. After a month's
residence by the seaside he returned home, apparently quite restored.
Some months afterwards there was a slight return of constitutional
symptoms, but not of the eye disease.
CASE XXVI.- Syphilitic Cachexia-Scre Throat-Ulcerated
Glands-Nodes-Laryngitis.
July 30th.- -, oet. 24. Got into a horrible state of syphilitic
disease in a hot climate, a year ago. Took a little Mercury six
months ago. The sore healed. He got cold; ulcerated sore throat
followed. The glands in the neck swelled, and there are now three
open ulcers on the right side of the neck, and some under the chin,



LIST OF
HOM(EOPATHIC WORKS
PUBLISHED AND IMPORTED BY
HENRY TURNER & CO.,
^Jjrieo    ft2i4  Grejii'st5  awO  Lebirda  Vnblis8jcrs'
77, FLEET STREET, LONDON, E.C.;
41, PICCADILLY, AND 15, MARKET STREET, MANCHESTER.
4** All Books, the published price of which is Is. or upwards, are
delivered post free to any address within the limits of the reduced
Book Postage.
AMERICAN HOM(EOPATHIC REVIEW.
*#* According to an announcement in the last number issued, this
serial will not be discontinued, as expected, but will in future
be conducted under the immediate supervision of Drs. B. F.
Joslin, P. P. Wells, Carroll Dunham, and H. M. Smith. Each
issue is supplied to Subscribers immediately on its arrival in
this country.  Terms, 14s. per annum post free, payable in
advance. Single copies, Is. 2d.
Intending subscribers should, in order to avoid disappointment,
send in their names early.
BRITISH JOURNAL OF HOM(EOPATHY. Edited by Drs. DRYSDALE,
DUDGEON, and ATKIN. Published Quarterly. Price to Subscribers
18s. per annum, post free; single copies, 5s.
*** This is the oldest-established Medical Quarterly in Great Britain.
BRITISH    WORKMAN'S      GUIDE   TO   HOMOEOPATHIC      TREATment: compiled chiefly from the Works of Drs. GUERNSEY, MALAN,
HERING and MOORE, with the object of rendering the domestic practice of Homceopathy in common ailments as simple as possible, to meet
the requirements of the working-classes. Limp cloth, Is.
COCKBURN (DR. SAMUEL). THE TWO SYSTEMS OF MEDICINE.
Cure Explained and Contrasted. Limp cloth, 2s.
DRUMMOND (DR. J.) HOM(EOPATHY AMONGST THE ALLOpaths, being a collection of evidence favorable to the tenets of Hahnemann and his followers, EXTRACTED FROM THE STANDARD WORKS OF
THE OLD SCHOOL. In stiff covers, Is.
DUDGEON      (DR. R. E.) LECTURES ON        THE THEORY      AND
practice of Homoeopathy. Cloth, 7s. 6d.
GLIMPSES OF HAHNEMANN, THE             FOUNDER     OF   HOM(EOPATHY: A compilation from various sources, illustrative of the Life
and Character of Hahnemann. Extra bound, gilt edges, 2s.



4
MOORE (MR. JAS., V.S.) VETERINARY IIOM(EOPATHY, ILLUStrated by 125 Cases, selected from many years' practice in the Homceopathic Treatment of Animals, with observations. Sewed, 6d.
"*4* To those unacquainted with the method of treating animals
Homoeopathically, this pamphlet is of the greatest assistance.
MORGAN (DR. WM.) DIPHTHERIA, ITS PATHOLOGY AND HOmoeopathic Treatment, with Cases illustrative of its Cure. Sewed, 6d.
NORTH AMERICAN JOURNAL OF HOM(EOPATHY. A Quarterly
Magazine of Medicine and the Auxiliary Sciences, with which is incorporated the ' United States Journal of Honceopathy.' Price 3s. 6d.
Posted free to Subscribers on the arrival of the first mail after its
publication in New York for 14s. per an., payable in advance.
REASONS FOR ADOPTING         HOM(EOPATHIC      TREATMENT      IN
the Diseases of Animals. Sewed, 2d.
REPERTORY (THE NEW); OR SYSTEMATIC ARRANGEMENT
and Analysis of the Homoeopathic Materia Medica.  This work is
expected to be completed in about six or eight parts, five of which are
already published. Post free to Subscribers for 4s. per part; to nonsubscribers, 5s.
SHARP (DR. WM.,F.R.S.) AN INVESTIGATION OF HOM(EOPATHY
in a Series of Essays. Seventh Edition, extra cloth, 5s.
SHARP    (DR. WM., F.R.S.) A    LETTER    TO   SIR   BENJAMIN
C. BRODIE, Bart., P.R.S., in reply to his Letter in ' Fraser's Magazine'
for September, 1861. Second Edition, extra cloth, uniform with the
'Investigation of Homceopathy,' 2s. 6d.
SHARP (DR. WM., F.R.S.) TRACTS ON HOMIEOPATHY.
1. What is Homceopathy? Eighth Edition. 2d.
2. The Defence of Homceopathy. (An answer to Routh's 'Fallacies of
Homceopathy.') Sixth Edition. 2d.
3. The Truth of Homceopathy. Sixth Edition. 2d.
4. The Small Dose of Homceopathy. Sixth Edition. (Single numbers
out of print.)
5. The Difficulties of Homoeopathy. Third Edition. 2d.
6. The Advantages of Homccopathy. Third Edition. 2d.
7. The Principle of Homceopathy. Third Edition. 2d.
8. The Controversy on Homoeopathy. Second Edition. (Single numbers
out of print.)
9. The Remedies of Homceopathy. Second Edition. 2d.
10. The Provings of Homceopathy. Third Edition. 2d.
11. The Single Medicine of Homceopathy. Third Edition. 2d.
12. The Common Sense of Homoeopathy. Third Edition. 2d.
(In all 48 Editions, comprising 173,000 Copies exclusive of the American
sale, which has been of equal magnitude. The series was begun in
1852 and completed in 1854.)
The complete series in stiff cover, 2s.



5
TEN REASONS WHY I PREFER HOM(EOPATHY TO THE COMMON
System of Medical Treatment. By the FATHER OF A FAMILY. Third
Edition. (Thirty Thousand.) In wrapper, 2d.
THOMAS     (DR. H.) ADDITIONS        TO   THE    HOMCEOPATHIC
Materia Medica; with explanations and remarks respecting the Provings
of Homoeopathic Medicines. Limp cloth, 2s. 6d.
THOMAS     (DR. H.) DISEASES      OF CHILDREN, AND        THEIR
Homceopathic Treatment.   Compiled from   the works of TESTE,
HARTMANN, WILLIAMSON, and others, with additions. Cloth, 3s.
THOMAS     (DR. H.) EXTERNAL        REMEDIES     IN   CASES   OF
Accident, &c. Third Edition, illustrated. Limp cloth, ls.
TURNER (MR. HENRY) ON THE FOOD OF YOUNG INFANTS;
or, Wet Nurses and Hand-feeding Superseded by the Discovery of a
true and exact Analogue of the Human Milk. Reprinted from No. LXI
of the ' British Journal of Homceopathy.' Sewed, 2d.
TURNER'S ILLUSTRATED        AND DESCRIPTIVE GUIDE IN THE
selection of a Homoeopathic Medicine Chest. Post free on application.
WILLIAMSON      (DR. WALTER). DISEASES OF FEMALES AND
their Homceopathic Treatment; containing also a full description of the
Dose of each Medicine. Second English Edition. Cloth, 2s.
YELDHAM (S., M.R.C.S.) THE MORAL EVIDENCES OF HOM(EOpathy. Two Lectures delivered at the London Homoeopathic Hospital.
Sewed, 6d.
YELDHAM (S., M.R.C.S.) REMARKS ON THE DIFFERENT MODES
of administering Homoeopathic Medicines, with a view to the disuse of
the Globule. Sewed, 3d.
YELDHAM     (S., M.R.C.S.) ARNICA, RHUS, AND CALENDULA. A
Lecture on ' Surgery as Modified by Homceopathy,' delivered at the
London Homoeopathic Hospital. Sewed, 6d.