§5ibra*tj of §v\\pt$$ DOTTED STATES OF AMERICA. PBACTICAL TREATISE. ***a A. PRACTICAL TREATISE ON THE DISEASES AND ABUSES OF THE SEXUAL SYSTEM, WITH ILLUSTRATIVE PLATES. BY JOSEPH RALPH, M. D., Graduate of the University of Edinburgh ^Member of the Royal College of Surgeons, London, ;-and Author of * lhe Family Physician," fyc, fyc "^^^a^I~^^^ arena EIGHTEENTH EDITION, REVISED AND CORRECT E. D. LONG No. 121 NASSAU STREET. 1857. 1 Entered according to an Act of Congress, in the year one thousand eight hundred and fifty-seven, by Joseph £. Ralph, M. 1>. CONTENTS Chap. I. — On Gonorrhoea— Its Nature, Symptoms, Progress, and Consequences. Chap. II. — On the Remedies and Treatment of Gonorrhoea. Chap. III. — On the Accidental Symptoms of Gonorrhoea, viz : Pain in Urinating, Phymosis, Paraphymosis, Chordee, Bubo, Swelled Testicle. Their Treatment. Chap. IV. — On Gonorrhoea in the Eyes, and Gonorrheal Rheuma- tism. Their Treatment. Chap. V. — On Gonorrhoea in Females — Its Treatment. Chap. VI. — On Gleet. Its Nature and Treatment. Chap. VII. — On certain diseases resembling Gonorrhoea in some respects, and which are frequently mistaken for it ; but which, nevertheless, are totally distinct and different dis- Chap. VIII. — On Leucorrhoea, " Female Weakness," or " Whites.', Its Treatment. Chap. IX. — On Stricture of the Urinary Passage. Its Nature, Symptoms, Consequences, Remedies, and Treatment. Chap. X. — On Masturbation, called also Onanism, Self-pollution , &c. Chap. XI. — On the Consequences of Masturbation. Chap. XII. — On Masturbation. Its Treatment. Chap. XIII. — On Syphilis or Venereal Disease. Its Distinguish- ing Marks, Nature, Symptoms, Progress, and Consequences. Chap. XIV. — On the Remedies and Treatment of Venereal disease. Chap. XV. — On Venereal Bubo, Phymosis, Paraphymosis, Venere- al Warts. Their Treatment. Chap. XVI.— On Venereal Sore Throat. Its Treatment. Ghap. XVII . — On Venereal Blotches and Eruptions on the Skin, Their Treatment. Chap. XVIII. — On Venereal in the Bones, Nose, Palate, fyc. Its Treatment. Chap. XIX. — On Venereal Taint in the Constitution. The effects of Venereal Diseases upon Posterity, The eradication of the Poison from the System. The Treatment of Syphilisin Infants. Chap. XX. — On certain Complaints which resembles Venereal Disease, and sometimes arise from Sexual Intercourse, but which, nevertheless, are not Venereal, nor can be treated as such without the greatest disadvantage. Persons affected with these are often cruelly imposed upon by advertising people. SHOULD BE CAREFULLY READ BY ALL MARRIED, OR CONTEMPLATING MARRIAGE. Having been frequently asked by patients if certain results could not be produced by either medical or mechanical means, or a combination of both : — after a series of experiments and the severest tests in a number of cases, the author is happy in stating emphatically that those results can be brought about by a mild and pleasant treat- ment, permanent in it3 effects, and attended certainly, with the most happy conse- quences to those who may be unfortunately united for life to one of a temperament the opposite of their own, and render married life one of happiness instead of misery* a blessing in lieu of a curse. Unfortunately for society, many are under the impression that all women are warm and passionate — that their bosoms swell more with soft desire than purer emo- tions. Fie upon you ! — harbor no such ungenerous thought ! Why do not men study female character, and appreciate her deservingly 1 She is g«ntle and confiding — often yielding without desire, because husbands wish and claim their privileges. Is there a husband who possesses one spark of affection for a devoted wife, who does not really wish that she may share all the joys of wedlock in the highest degree 1 1 think not ; and yet how many who, not from want of will or ordinary capacities* but from want of self-controlling power, cannot bring about the extatic pleasures 1 In prescribing treatment for diseases or derangements of the'sexual organs, there are many points of singular and peculiar interest, which should be kept in view. In many cases there may be no disease, deficiency or malformation ; yet, the precipitan- cy or quickness of the male in the sexual embrace is often a source of mortification and disgust to the female. In married life there is indeed much suffering and vexa- tion. A most tantalizing source of annoyance is when there is so great a difference in natures, passions, &c , that there is no real enjoyment in the copulative act, the male being too quick in almost all cases. It is to this important point that I would call your special attention. There are certain means by which the activity of certain organs, and their auxili- aries, can be equalized, and only during the act can sufficient of the active principle be secreted to consummate the act, consequently the pleasures must be more endur- ing, and much greater. This treatment is offered only to those married, or contem- plating marriage, and is calculated to bring opposite sexes (ro matter how great the difference m natures,) to a mutual reciprocation of thoughts, feelings, desires, &c, and without which, there is little, if an}% real enjoyment in married life. During this treatment there is little medicine used, few if any restrictions required* the general health improved, the tone and vigor of the organs fully restored, no matter how weak or sensitive they may have become from excesses, or a total absti- nence from sexual commerce ; will also enable either and both parties to prolong the act and increase the extatic pleasures. Puritans may scoff, the bigotted sneer, and fools laugh, but the Author begs to state emphatically, tbat in the event of a reflecting commuuity's allowing him to practically demonstrate his views, the result must be that every wife will have the best husband, and every husband the best wife in the world, because they will be mu- tually satisfied and pleased. The moral influence which must result is quite clear to every intelligent and re- flecting mind. No satisfied and happy husband or wife will ever give the substance for the shadow ; — they will never seek and risk finding pleasures abroad which they are certain of having at home. # All deficiencies, malformations, weaknesses, &c, treated carefully and successful- ly. All letters to receive attention, should state case fully, and enclose the usual consulting fee. Address, W. H. MORRIS, M. D., Box 869, P. O., N. V. City. CHRONIC AND CONSTITUTIONAL DISEASES, In order t>? correct an erroneous notion that many entertain since he relinquished a general or family practice, Dr. Ralph would here observe that he has for some years past confined himself to an Office-practice, for the treatment of all Chronic Affections, as well as those referred to in his " Practical Treatise ;" and that, associated with him in this practice is Dr. Wm. H. Morris, late of Nashville, Tenn., who for seve- ral years has had an extensive and successful practice there in Chronic and Female Complaints, fyc. By thus restricting the practice to this important and too generally ill-treated class of diseases, we are enabled to give them that attention they demand, and for the want of which their treatment (in the hands of Physicians generally) so often proves unsatisfactory and useless, if not even worse. Drs. Ralph and Morris, therefore beg to call the attention of those laboring under Chronic complaints to the following remarks : These affections require a judicious and careful treatment, varied according to the stage of the disease, as well as the age, sex, habits, &c, of the patient ; unless this be observed strictly, little if any good can result from any treatment, even though followed for half a lifetime. "We wish it understood that we do not use specifics, but treat all patients in a scientific and thorough manner ; and where directions are strictly followed, will warrant safe and permanent cures. Dyspepsia and Liver Disease, and all the consequences attending derangement of the Organs of Digestion, Irregular Bowels, Flatulency, Nervousness and Hypo- chondria, fyc. Piles — a disease closely connected with the above, is cured without an operation in a few days. Those who apply early will find relief in a few hours. Rheumatism, Scofula and Skin Diseases, Fistula, Dropsy — will find a thor- ough treatment and pleasant cure. Diseases of the Bladder and Kidnies, Gravel, Enlargement of Prostate Gland, and all Urinary complaints; Stricture of the urethra; also, all derange- ments and weakness of the sexual organs in either sex, admit of positive and radical cure without the use of mercurials, or any offensive medicines or tiresome restrictions. Asthma — and all chronic Affections of the Lungs ; in the worst cases of Asthma, relief may be obtained in a few days, and a permanent cure can be effected in a short time. Female Complaints — than which no class of diseases require a more careful arid judicious treatment to produce a permanent good, are treated in a safe and skillful manner, pointed out by a long course of successful practice. Ladies who desire a safe and easy time should make application a few weeks before the time of accouch- ment. It should, however, be distinctly understood that the subject of prevention or abortion is not here included — time and trouble will be saved by neither calling nor writing on this subject. Safe, pleasant and positive treatment for the removal or Worms, Eruptions of the Skin, and all Chronic complaints peculiar to infants and children. Diarrhcea, Dysentery, Bowel Complaints, &c, speedily and effectually cured. In time of Cholera a remedy is kept constantly prepared, a single dose of which will arrest the premonitory symptoms, and a very few doses will cure it when fully set in. This medicine is pleasant to the taste, perfectly safe, (containing neither opium, lead or any dangerous ingredient), and has been fully tested in several Epidemics. We should, at such time, always be pleased to give a dose to any one having the premonitory symptoms, who will call at our office. JOSEPH RALPH, M. D., WM. H. MORRIS, M. D., (Author of the "Practical Treatise" fyc.) {Formerly of Nashville, Tenn.) Offices, ^MM teew -St reet, near Webster, N. Y. City. At Home till One and alter Six O'clock, (Sunday excepted.) Patients visited at their Hotel if necessary. Treatment by Letter. — Patients at a distance, by stating their symptoms, &c. will meet with prompt attention. All Letters must enclose a fee, and may be diricted to Box 869, P. O., New York City. Medtcines — are securely enveloped and safely sent to all parts of the United States, Canadas, South America, West Indies, &c. P. S — For some important remarks and suggestions to the married, or those con- templating marriage, enclose two U. S. postage stamps, addressed, " Box 869 P O." The following remarks upon a most common but least understood disease, viz. : Stricture, its Symptoms, Effects, fyc, will, it is believed, prove interesting to many : — 1st. — That Stricture is a very common malady, and frequently exists in those who are not the least aware of it. 2d. — That a very erroneous notion prevails with regard to Stricture. 3d — That although a Stricture may long remain so dormant, as not to be sus- pected, it is always tending to other forms of sexual disorder. 4th. — That there are three circumstances in particular, by which a Stricture may always be known. 5th — That the cure of Stricture, especially in its early stage, is certain, free from pain or inconvenience, and generally accomplished in a very little time. 1 — With regard to the frequency of Stricture, this will not surprise if it is con- sidered that this complaint proceeds from a badly treated Gonorrhoea. If for instance this disease has been suffered to continue on from month to month, it slides into a Gleet. Now, there is no pain or inconvenience in Gleet, and on this account it is often suffered to remain for any length of time. But it should be known that Gleet is generally connected with Chronic Inflammation, which naturally terminates in thick- ening, and this thickening in one part or other of the urinary passage is Stricture ; and further with regard to its obscurity, this thickening may exist without a Gleet, and in that case there is nothing whatever to call the attention to it, so that the gufferer must remain in perfect darkness as to the real nature of his malady. 2 — Another thing that leads the attention off from this disorder, is the erroneous notion that stricture cannot exist so long as no impediment to the flow of urine is observed. But this is quite wrong. A stricture may exist for years without producing any striking change in this respect. Indeed this effect upon the urine, is observed only in advanced and older cases, while the visible effect of early stricture is not on the part itself, but on the mind, causing lowness of spirits and want of resolution. 3 — But, although a mild or early stricture is seemingly inactive, and of no account, it is far from being really so. It is scarcely possible for those not acquainted with minute anatomy, to imagine the delicate and peculiar structure of the part which is the seat of this disease, and how little is sufficient to derange it. Now, this morbid condition of the passage whether connected with stricture, or induced by other and pernicious causes, is ever tending to destroy those delicate organs, laying the foun- dation of some of the most distressing maladies of human nature. It is in this way that melancholy and even suicidal feelings, dyspepsia, local debility, too great quick- ness* in the sexual act, impotence, an irritable bladder, and other like diseases, proceed from a mild and unsuspected stricture. 4 — Nothing therefore, can be more desirable than to have some plain and ready means of detecting stricture in its mild and early stage ; and, fortunately , there are three particular circumstances, which for many years, the author has found to suit this purpose. They are the following. The first relates to — The Manner of Urinating. — It has been said already that the stream need not be much diminished or impeded, and that is true ; but observe what happens after this is finished, and the clothes are readjusted, and if it should be found that a drop or two will afterwards steal away, so as to wet a little, this, trifling as it may seem will afford a ground of strong suspicion. The next regards. The Time a Former Disease may have Remained Uncured. — It is not so much how long ago it may have occurred, as how long the gleety stage may have continued. Neither is it possible in every case to state the length of time a gleet may run without producing stricture, for one is naturally more disposed to stricture than another. Asa general rule, however, if a Gonorrhoea has been suffered to continue * This quicknkss or precipitate discharge in the sexual act. is s» cau e of no little annoyance to the married on hoth s de — in the o e causing shame aid mortification as well as deprivation of due pleasure— on the other, a dissati fied feeln g, often resulting in di gust of the ac altogether, and of- tener tha» is supposed, being th» fumstance. Also the praetice of Masturbation, or self-abuse >n youth, m a common cause. The third is The Effect a Stftcturk has upos the Miw.-This, in the early stage, is to depress theTpirit" and to lessen mental energy. It is also one of its most mvanable tffe NoWhat this is seen in the same degree in every individual but .t ,s so com- t Id, writer scarcely sees a case of stricture in which ,he PaUeutdoesnoUom. plain that he is less active, and less capable of business than formerly Much ^gh be advanced to show the natural connection of the m.nd and genera .veogans but for this the reader is referred to the Author's " Practical Treatise," whde the fact itself is proved by the return of mental energy as the cure proceeds. S^-With respect to the cure of strieture-this may now be accomplished in very Tear's To those who cannot leave their homes, his own peculiar means o ur , with Z tmrZus adapted to each particular case, can he ^^^^ "f t0 any part of the United States, Canadas, South America, or West Indies, &c. A LL Lkttkhs must enclose a fee, and are addressed to JOSEPH RALPH, M.D. Box 869 P. 0., N. Y. City. (The name may be omitted if preferred.) Offices, 6*3 Houston -Street, near Wooster, N. Y. City. ygy /dM^AtJ^*-^ C« At Home till One and after Sit O'clock, (Sunday excepted.) Patients Tisited at their Hotel if necessary. PRACTICAL TREATISE. &c. &c. PART THE FIRST. CHAPTER I. On Gonorrhcea. — Its Nature, Symptoms, Progress and Consequences. The first thing to know on this subject, is, that Gonor- rhoea and Venereal Disease are two distinct and very different disorders. A person having Gonorrhoea, for instance, cannot give another the Venereal disease ; nor can one having Venereal Disease give to another the Gonorrhcea. Neither, again, can a Gonorrhoea change into the Venereal, nor Venereal into the Gonorrhoea Both diseases, however, may perchance exist in one and the same person, and then, both may be communicated at the same time, or one alone, just as it may happen. Hut the thing to be remembered is, that they are two di i :~ find diseases, and this is the more important, because, as I shall presently have to show, they require very differ- ent remedies and modes of cure. I will now proceed to give a description of the first of these complaints — the Gonorrhoea — the one upon which we are now engaged, and this shall be done in words as few and as plain as possible, so that, by comparing it with the description of the Venereal, which shall imme diately follow, any one may see the difference between these two diseases in a moment. Gonorrhoea, then, is an infectious disease ; it is seated in the urinary passage, from the orifice of which there issues a discharge of matter, attended, more or less, with pain and heat in making water. There is no outward sore or ulcer in Gonorrhoea; neither indeed is there any within the passage. If it were possible to take an in- side view of the urinary passage, nothing would be seen there but redness and a little swelling, and the discharge, whether much or little, would be seen issuing from the red and swollen state of the membrane which lines it just as matter is sometimes seen issuing from an inflamed eye Venereal Disease, on the contrary, is not seated in the urinary passage, but externally, on some part or other of the penis or genital organs, and consists in one or more little ulcers or sores, which do not heal like others, but continue unhealed, and, at length assume a peculiar cha- racter. Gonorrhoea, then, consists in a discharge from the urin- ary passage, attended, more or less, with pain and heat in making water, without ulceration or sores ; whereas Ve- nereal Disease consists in external ulceration or sores, without discharge from the urinary passage, and without pain or heat in making water. No one, it is presumed, after this can possibly mistake these two diseases, and it will therefore now be proper to describe particularly how a Gonorrhoea commences and proceeds. But before entering upon a particular history of this disease, it is desirable to say a word or two respecting the time when a Gonorrhoea first appears after an exposure to it; for many persons wrong themselves with dread and apprehension long after there is the least occasion for it ; To the question then so often put, — When may 1 consider I am safe? I reply, after the seventh day, if none of the symptoms presently to be mentioned should appear, you may consider you have escaped, — that you are safe. It is true there is some difference in the time of its appearing in different individuals. Some have said, for instance, they have known it to appear in twenty-four hours, and others that it has ! ^een delayed for ten or even fourteen days. I very r^uch doubt, however, whether it ever ap- pears at this early period. Instances of this kind which have occurred to me, have always proved to be cases of Stricture, not of Gonorrhoea, the discharge being the im- mediate consequences of an irritation of the pre-existing disease ; while those delayed for fourteen days are very rare. I never met with one myself, though such are occasionally related to me. By far the most common period is the third day. The seventh is the longest I have ever met with, and it is on the ground of this experience I venture now to say that, whoever has passed the seventh day without any of the symptoms presently to be men- tioned, may consider he is safe — that he has escaped — however suspicious the party may have been. This much then as to the time when a Gonorrhoea begins, and now as to its manner of beginning. A person having been exposed to this infectious malady, at some period within seven days, if he should have taken the disorder (which we will suppose to be the first attack) will feel a little pain and heat in making water. This leads him to make an examination, when he will find the orifice of the urinary passage looks a little redder than usual, its lips rather pouting or swollen, and on squeezing it, an uncommon dampness or thin mucus will be seen. In the course of a few hours, or by the next day, the pain and heat in making water will have increased, the discharge also increased and of a purulent or white creamy appearance. For some days these symptoms go on increasing in severity, the matter becoming of a yel- lowish color. Sometimes the pain and heat in making water will be exceedingly great, amounting to a sensa- tion of absolute scalding: at this time the discharge generally turns to a greenish color, and instead of being about as thick as cream, is thin and watery. Under these circumstances there is also a painful sensation along the whole length of the urinary passage, and the penis swells and is subject to attacks of frequent and very painful erection. A Gonorrhoea always begins with pain and inflamma- tion, more or less, which, after a little while, abates or subsides entirely. In speaking of a Gonorrhoea, therefore, we call the beginning of it, its Inflammatory Stage. But the degree of pain and inflammation at the beginning of Gonorrhoea, differs exceedingly in different persons; some will have so little as scarcely to complain at all, while others suffer most severely ; as a general rule, however, the oftener it is had, the less inflammatory is its attack, so that, those who have had Gonorrhoea several times may experience actually no pain at all, the only notice of its existence being the appearance of the matter on the clothes; but, in every case, after a time, this inflammation subsides, whether anything is done for it or not. Persons (coming from some of the advertising quacks) will often say, "but the stuff they gave me removed the burning pain," when, in fact it has nothing at all to do with it ; for unless the heating things they generally give increase the burning pain, it subsides itself, spontaneously This then is the first or Inflammatory Stage. The seat of Gonorrhoea, at its commencement, is just within the orifice of the urinary passage, this necessarily being the part that first comes in contact with the infec- tious matter — that first receives the inoculation. But the disease is not long confined to this spot, its tendency is to progress further and further along the urinary canal until it reaches to very near its other end, and there it settles down. How long a time it may occupy in its progress through the urinary canal, is uncertain, and differs in different individuals and under different circumstances of constitution, mode of life, &c. The painful inflammato- ry symptoms however, seem principally to attend the in- vasion of the disease, and, most of all, its effect upon the first portion of the passage ; when these are subsided, at any rate, we may consider it has advanced to its ordinary distance. After a long time then, or, if there has been much pam, after this has subsided, another stage of the disease com- mences. This stage consists simply of an infectious dis- charge issuing from the orifice of the penis, with little or no pain. This discharge is more or less in quantity in different persons, and is much increased by whatever may excite, or by irregularities of any kind. This, especially when the discharge is slight and quite unattended with pain, is what is properly called " Gleet," (see Chapter vi.), and, when once suffered to commence, there is no exactly telling how long it may continue, or how it is to terminate ; but let it ever be remembered, that, as long as this discharge continues, the disease may be communi- cated by infection. This, then, is the Second or Chronic Stage of Gonorrhoea. But thus far I have spoken of a Gonorrhoea in its sim- ple form, and have mentioned those symptoms only which are essential to it, and which are never absent from it; there are however other symptoms which are only some- times present, which may or may not exist, but which, when they do occur (and some of them generally do) form the severest part of the complaint and call for immediate and peculiar remedies. In fact, it is for the want of knowing something of the nature of these accidental symp- toms, that Gonorrhoea assumes its most distressing cha- racter, and leads to the worst consequences. Those cir- cumstances which may or may not occur in Gonorrhoea, and are called accidental symptoms, are the following : a swelling of the prepuce or foreskin ; — swelling of t&e glands in the groin ; — very painful erections of the penis ; — and swelling of the testicles. The nature of these therefore is now to be explained, but the particular mode of treating them will be given in another Chapter, (in). First, then of Swelling of the Prepuce or Foreskin. This is the effect of inflammation, which a full and irritable disposition or irregularity of habits gives rise to. The structure of the skin which covers the head of the penis (the prepuce) is very loose and cellular, so that when the inflammation happens to be high, this structure fills with the thin and colorless part of the blood which causes it to swell. Sometimes the skin is swollen amazingly, and looks of a bluish white color, being half transparent, and is very apt to create alarm. Indeed, there is sometimes reason for alarm, for when this swelling is considerable, the skin cannot be pushed back over the penis, or, if pushed back it cannot be brought forward again, so as to cover it Now, there is not so much danger in this swelling itself, as in the consequences of it; for if the skin cannot be pushed back, the matter under it accumulates and becomes acrid and irritating, and you cannot avail yourself of clean- linesss, which is always of importance. And, on the other hand, if you cannot bring the prepuce forward, it pro- duces danger by acting as though a string were tied around the head of the penis, preventing the return of the blood, so that it swells prodigiously, looks blackish, and sometimes even mortifies and comes away. This, how- ever, can always be prevented by proper management, which will be shown as I have already said, in a fol- lowing chapter. It is called a Phymosis when the skin cannot be drawn back from over the gland, or head of the penis, as in the former instance ; and a Paraphymosis when, being back, it cannot be brought forward again over the gland. Swelling of the Glands in the Groin. This also is the result of inflammation, spreading to the glandular bodies situated in the groin. In every part of the body there are certain little vessels called absorbents; and these, in their course, run through absorbent glands, of which there are several in each groin. Now it hap- pens that inflammation in the urinary passage is commu- nicated through the medium of these vessels to the glands in the groin, which become painful and enlarged in con- sequence. It is however worthy of remark, that in Go- norrhoea, glandular swellings seldom go on to form an actual bubo (which is an abscess in the groin) as they are apt to do in Venereal Disease, so that they are com- paratively innocent; after a little time they generally subside and disappear, (see plate 3). Another of these occasional symptoms is Frequent and very painful Erections of the Penis. This is a distressing and tedious symptom, the nature of which I will endeavor to explain ; — in fact it is nothing more than inflammation extending from the lining mem- brane of the urinary passage into the substance and body of the penis ; and it seldom occurs unless the inflamma- tion runs high. The structure of the penis is remarkable, (see plate 1). It is made up of large cells, into w r hich the blood is determined under certain circumstances of excitement, and when these are filled, the penis is erect. Now the effect of the inflammation having passed into the walls or substance of the urinary passage, and into this cellular tissue, is to deprive these parts of their natur- al elastic, yielding nature ; they become thickened, tense, unyielding, so that when the blood rushes in, as we know it does under sexual and other kind of excitement, pro- ducing enlargement and elongation of the penis, these EXPLANATION OF PLATE I. Figure 1. A transverse section of the penis, exposing its internal Cellular or Spongy Structure, and the blood- vessels ramifying through it ; this is called an Erectile tissue. Erection of the penis takes place by the filling up of this spongy texture with blood which for a time is retained in it. It is seen that the spongy structure is in two separate masses, and forms the bulk of the body of the penis. The three or four small holes above are the blood-vessels running along the back of the penis ; — the larger hole underneath is the urinary passage — which is observed to have another spongy texture surrounding itse 1 separately. The inner lining skin of the passage (th, seat of Gonorrhoea, &c.) is seen thrown into longitudinal folds, which enables it to expand or open when the urine passes, or when its spongy tissue is expanded during erec- tion. This is generally the seat of pain in Chordee. Figure 2. A highly magnified view of a portion of the Spongy or Cellular tissue. PLATE I Hk Figure 1. -=*V Figvre 2. EXPLANATION OF PLATE II. Figure 1. represents the Testicle, and attached to one side, the commencement of the Chord, composed of the Blood-vessels, Nerves, and Seminal Tube, i. e., the tube which conveys the Semen from the Testicle. Figure 2 shows a dissection of the Chord, in which everything is removed except the Seminal Tube itself; this is seen to be exceedingly small and delicate, and thrown into innumerable convolutions from the spot where it emerges from the Testicle at the top, and so continued til] it reaches the bottom, where it gradually becomes thicker and less intricate, at last ending in an almost straight tube : it has been unravelled and found to mea- sure no less than thirty-two feet in length. This delicate organ is the seat of disease in Swelled Testicle following Gonorrhoea and other inflammations of the urinary pas- PLATE II. Figure 1. Jf Figure 2. parts resist, are stretched with difficulty, or even torn, giving excessive pam. Sometimes, thus thickened and altered by inflammation they will hardly yield at all, the figure of the penis is then more or less crooked, as we often see ; the pain accompanying this is terrible. It is what is called Chordee, — the prevention or cure of which we shall presently come to, (Chapter in). The fourth and last of the occasional symptoms of a Gonorrhoea is Swelling of the Testicle This I consider a very important thing, for here the pain is so great, and the necessity of rest and lying in bed so urgent, that it is difficult to cure such cases with that secrecy which is so often desirable. Much however, may be done to prevent it, if early attended to, and therefore the symptoms which precede and lead to it, shall be no- ticed carefully. The first thing w 7 hich precedes a swelling of the testicle is a sense of pain running down the whole length of the urinary passage, accompanied w 7 ith a feeling as if a drop or two of urine were remaining in the passage after making water. To this there succeeds a dull pain in the groin, going on to affect the testiclej which presently feels heavy and very fender to the touch ; or, the pain and tenderness of the testicle may set in at once without any of these premonitory symptoms. No time should be lost. It should be attacked instantly, in order, it possible, to arrest the inflammation belore fuliv -tevetonetf The seat of the disease is not in the body of the tes- ticle itself, but in a small organ attached to it, (see platt 11), which, in a healthy state can, by carefully feeling around the testicle, be discovered at its lower and bach part ; it is small, loose, and feels like a collection of fibres When attacked by inflammation it becomes exquisitely sensitive and painful to the touch, and swells rapidly, be- coming at the same time hard and solid; it will then often exceed in bulk the testicle itself. The treatment, will be found in Chapter in. Inflammation of the Bladder. Is stiil another consequence of the extension of the primary gonorrhceal inflammation — to the neck of the bladder. This part is naturally very sensitive, and, when inflamed, becomes so irritable that the contact of the urine or slight distention of the bladder gives rise to pain and desire to urinate. It may be slight, causing merely the inconvenience of too frequent micturition with diffi- culty of restraining it ; or, the bladder may empty itself every five or ten minutes, passing only an ounce or two of high-colored urine, with great pain, and followed by blood, the desire to urinate remaining unrelieved. It is then attended with fever. This affection oftener appears in a mild or sub-acute form, but may set in with great severity, and is then a most harassing and painful addi- tion to the Gonorrhoea, it is therefore prudent to use means tor its pretention or cure directly a tendency to it is observed, as direcieu in OLapter in. The position o* EXPLANATION OF PLATE TIT Showing the Glands of the groin, and the absorbent vessels coming from every direction to pass into them. It is the inflammation of these glands that constitutes Bubo. If, from any cause, one of these vessels is injured or inflammed, the inflammation generally passes along till the vessel merges into a gland, where it settles, caus- ing the gland to swell and frequently to suppurate. Thus, if a chancre on the penis or the inflammation of a Gonorrhoea happens to implicate one or more of these little absorbent vessels, several of which are seen passing along the penis and testicle, the effect is immediately transmitted to one or more of the glands of the groin, and Bubo, as it is called, is the consequence. PLATE III. ^9 W^i v"il f 1 3* the neck of the bladder, the seat of this inflammation, is shown in plate iv. This then, is all that need be stated on the nature, symptoms and progress of Gonorrhoea. With regard to its consequtijoes, tiiey are, indeed, severe and paiiiful, but there are other remote consequences which are of infinite- ly more importance, so much so as to demand separate and lengthened attention. The consequences to which I allude are Gleet and Stricture, which latter, growing as certainly out of Gleet, as Gleet does out of Gonor- rhoea, again gives occasion to a train of symptoms the most lamentable that can be conceived, of which Impo- tence is one. Does Gonorrhoea ever wear itself out ? Before I leave this subject, I would remark that many have put this question to me, — Does this disorder (Gonor- rhoea) ever cure itself? — does it ever wear itself out ? To which I have always replied, It may do so ; but it is a most terrible risk to run; for not only will it wear out the patience of the patient, but will leave open the widest door for the consequences I have just enumerated. The general consequence of a Gonorrhoea, if not early and properly treated, is a Gleet, and a Gleet implies a cer- tain morbid state of the urinary passage, which, if long continued, is almost sure to terminate in Stricture, a disease than which I know nothing that, in the hands of most people, is more baffling and truly lamentable CHAPTER II. On the Remedies in general use for Gonorrhoea; — How far they are to be depended on ; — To tohat parti- cular cases they are suited, — and, How to use them to the best advantage. The remedies for the cure of Gonorrhoea are very few m number and are pretty generally known, Notwith- standing this, however, their real nature is but little un- derstood, so that they are constantly misapplied. They are internal and external. Of the first, the Balsam of Copaiva and the Cubeb are the chief; the external or local remedies consist of lotions, used as Injections. The Internal remedies are vegetable productions, which in their properties very much resemble one another. All of them impart their virtues to the urine, w 7 hich being retained in the bladder, impress upon it their peculiar ef- fect, and this again is transmitted to the part which is the seat of the disease- — the urinary passage.* On the other hand, Injections are generally mineral substances, and * This has be?n repeatedly proved. severed near the scrotum : he conse- Whilst attending the Clinique of the quentiy urinated principally by this renowned Ricor ; , at the Hdpital des as tificial opening, and, at both this and V6ceriens, of Pari-?, I had an opportu- the natural opening, the gonorrheal nity of witnessing a raro and curious matter escaped. The Balsam of Co- case, very illustrative of this fact. A paiva waa ordered him, and in a few man was admitted into one of the wards days the discharge from the posterior (Salle 2 I believe) having a severe half of the urethra was entirely check- Gonorrhoea; he had, by an accident, ed, whilst from the anterior half it some year3 previously got his urethra flowed almost or qu tte as freely as ever consist of certain suitable stimulants, which are applied more immediately to the seat cf the disease by means of a Syringe. Both kinds of remedies are exceedingly valu- able in their proper places, but they are also, both of them, either useless or dangerous if improperly used or misap- plied. The object of this Chapter, therefore, is to explain their use and nature more particularly It should also be stated, there are other remedies which are occasionally wanted in the cure of this complaint, but not always; these are, chiefly, the common remedies re- quired to lessen pain and inflammation. Various things are used with such a view, but there are some which are far more suitable than others ; an account of these there- fore I will afterward subjoin, pointing out their proper use and dose, as well as making such other, observations on them as may seem required. The successful treatment of these diseases depends more especially on the right management of the remedies in any given case. The Balsam of Copaiva. This, every body knows, is very often given for the cure of Gonorrhoea; indeed, Balsam of Copaiva, as a remedy for Gonorrhoea is so well known, that whoever discovers to another he has taken it by the peculiar smell it gives the breath, is generally set down for one who is contaminated with Venereal malady. Balsam of Copaiva is, beyond a doubt the best of all the internal remedies, but it has its objections, and the circumstance just men- tioned is one of them. Another is, its extreme offensive- ness to the taste; and a third, its offensiveness to the stomach, so that it is rejected by vomiting, or, if not re- jected, it takes away the appetite and induces a degree of nausea which can scarcely be endured. Indeed, it is a medicine, to some, so perfectly obnoxious that tbey can- not even think of the time of taking it without nausea or vomiting. With respect to the two first of these objec- tions, however, (its offensive smell and taste), the latter of these may be avoided by taking it in Capsules, and the former partly so. These Capsules are small glutinous bags, which are closed, and contain a little of the Balsam. These little bags, when swallowed, are soon dissolved in the stomach, and thus the Balsam may be taken and its disagreeable taste avoided. The peculiar smell imparted to the breath, however, is not got rid of by this means ; for, especially when it disagrees, the stomach is continu- ally expelling wind, and this affects the breath offensively and is equally betraying. But_the most important of the objections to the Balsam of Copaiva (that of disagreeing with the stomach and digestive organs) is not avoided by this ingenious way of giving it; for when the Balsam dis- agrees, it does so whether it is tasted in the mouth or not. These things, therefore, taken altogether, are great ob- jections to the Balsam. But there are others still to be acquainted with. One is, the fact, that there are many persons in whom the Balsam of Copaiva has no effect at all in curing this disease ; and there are others in whom it will stop the discharge, so iuu 8 as it is taken, but the moment it is laid aside, the disease or running returns. Now it is of no use for either of these to take the Balsam, or to continue it alone, at any rate If such were to take a ship load of this medicine, it would never cure them. When the Balsam does good at all, it does so very soon, by lessening the discharge. A good rule in taking the Balsam of Copaiva is, to watch its effect, and if it do not, within two days, or three at furthest, very sensibly lessen the discharge, lay it aside, or add some other re- medy to the treatment. There is also a time when the Balsam of Copaiva should not be given ; this is when the inflammatory symptoms of a Gonorrhoea run high. We always look for more or less of such inflammatory symptoms at the onset of this malady; sometimes indeed they do not happen, but they should al- ways be prepared for. It is with this view we always give an active purge or two, and direct low diet and rest if it can be had, at the beginning of a Gonorrhoea. This some- times prevents altogether, and if not, it abates them. After an active purging medicine, therefore, if there is no great pain and heat in making water, you may begin with the Balsam; but if there is, it should be delayed, however many days it may require to modify these symptoms. Likewise, should you have commenced with the Balsam, and inflammatory symptoms at any time start up, lay it aside, and first abate these painful symptoms before you begin with it again. I know that some begin with Bal- sam of Copaiva under any circumstances, and many times with impunity; but I also know that when it has been given without attention to these circumstances, it has sometimes been followed by distressing and even danger- ous events, as inflammation of the bladder, testicles, &c. But notwithstanding the truth of these remarks, the Balsam of Copaiva, when it agrees, and it is convenient to take it, is a remedy of considerable power in the cure of Gonorrhoea. Sometimes it is trusted to alone, but then, for any chance of success, it must be taken in a cer- tain and well regulated manner, and cautiously abandon- ed. Let it be always remembered, however, that, where it can do good, it does so quickly; perhaps in two days the discharge is lessened one half, and it then goes on more gradually to diminish. But let it also be remem- bered that in those cases where it is equal to the cure alone, that cure would be affected in less than half the time if given in connexion with local remedies — Injections. If the Balsam of Copaiva is fixed on as a remedy for Gonorrhoea, it should be given in the dose of about a tea- spoon-full, not less than thrice a day. It may be taken simply in a little water, on which it floats like castor oil ; but generally it sets better on the stomach when made in the form of a mixture or an emulsion. If it happen to purge, omit it for a day and take a dose of Rhubarb. If this will not do, add to each dose of the Balsam four or five drops of Laudanum. It should be continued for some time after the discharge has ceased, and then left off only by degrees. This is all that need be said about the Bal- sam of Copaiva, The Powdered Cubeb. This is an admirable remedy if properly availed of, and is free from the offensive smell of the Balsam of Copaiva, it is also a pleasant, wholesome aromatic, and generally agrees with the stomach. Neither is there the same de- gree of objection to giving it in the very onset of the dis- ease (provided high inflammatory symptoms have not set in) as there is to the Balsam; indeed, such is its peculiar effect, that if given freely and early, it sometimes super- cedes the inflammatory symptoms altogether, and leads to a very speedy cure. If, however, inflammatory symp- toms have already suddenly come on before you have had an opportunity of using the Cubeb, it is then more safe and proper to reduce these sj^mptoms by rest, purging and diet, before you venture on this remedy. So also, if you had begun early with the Cubeb and such inflam- matory symptoms should happen to arise, let it be discon- tinued for a while, or until these symptoms have been abated by the means above referred to, and then resume the Cubeb. The best way of taking Cubeb is in the dose of a j piled-up teaspoon-full, mixed in a tumbler of water, and repeated twice or thrice a day. It is of no use to take it in small doses, as many do. There is something also in the manner of taking it. The best way is to fill a tumbler half full of water, then put a teaspoon-full of the Cubeb upon the water, and in a minute or so it will have sunk from the surface to the bottom, and thus is equally dif- fused ; you then give it a stir and drink it off. Should the Cubeb irritate the bowels as a purgative, this may be checked by adding five drops of Laudanum to each dose; but if it only prove a little laxative, to this there is no objection. The virtue of the Cubeb should be separated by the kidnies and carried into the bladder, and of this you may always be assured w T hen a peculiar smell is imparted to the urine, — a kind of violet smell, — not unlike that which the urine has on taking turpentine, or when an individual has been exposed to breathing the atmosphere of a newly painted room. But, although I have said so much in favor of the Cu- beb, let it not be thought that it is to be depended on in every case. On the contrary, there are many individuals in whom it seems to have no good effect at all ; and others in whom it will stop the discharge so long as it is con- tinued, but the moment the remedy is laid aside the dis- ease returns. And what was said of the Balsam of Co- Daiva is also applicable to the Cubeb; — viz., when it does any good at all, it does so quickly ; so that if you do not see the most decided advantage from its use in two or three days, but little or none is to be expected fiom & EXPLANATION OF PLATE IV. The various medicinal substances taken into the sto- mach for the purpose of acting upon the urine and the urinary organs, can only reach these along with the cur- rent of blood, into which they have been absorbed, as it passes from the main artery of the body into the Kidnies by A, A, — The Renal Bloodvessels. During the circu- lation of the blood through B, B, the Kidnies, the refuse matter destined to form the urine, as well as certain medicinal substances, is seperated from it, and passes in the form of urine along C, C, — The Ureters, into D, — The Bladder, or reservoir of the urine. E, — Is the Prostrate Gland or neck of the bladder, and F, — The Urethra or urinary passage, which, with the bladder and prostrate gland, are represented laid open. PLATE IV The inconvenience of its bulk, and the mode of taking it, are also in some cases a great objection to the use of the Cubeb. The virtues of the Balsam of Copaiva and the Cubeb have now been fairly stated, and the objections to them shown. To this again must be added their uncertainty, for, in many cases they entirely fail. The fact is, that many cases of Gonorrhoea defy the virtues of internal medicines alone, and absolutely require the aid of local remedies, injections, with which, judiciously and skill- fully managed, the cure is accomplished in less than half the time, and is far more safe and certain. In cases of unusual difficulty or obstinacy, other local applications are used, but they can only be used under the immediate direction of the surgeon; they could not therefore be properly described in a work of this kind. Injections. The use of these forms an invaluable part in the treat ment of Gonorrhoea, — it is applying the remedy to the disease itself — the advantage of which can scarcely be doubted. Yet there are some who are opposed to Injec- tions, simply, as it would seem, because they may be abused. But carry on this reasoning to other diseases — say Ophthalmia, for instance. Internal remedies, then, are very good in Ophthalmia, and sometimes will cure it, but who would withhold the use of Lotions and other ap- plications to the eye itself, simply because they may be misused or abused. Is there a single medicine which may not be abused? Quite the contrary, — and the most valuable too are the most capable of such abuse. Oh I it is said, they may cause a Stricture ; and so may Lo- tions and Ointments put out the eye; but, if properly used, they will save the eye, and cure its malady, and this in less than half the time it could be cured without them. Indeed there are many cases of the eye that can- not be cured at all without them, and so of Gonorrhoea. As to the idea of Injections causing Stricture, nothing can be more ridiculous; for, on the contrary, they prevent it. The ultimate result of a Gonorrhoea, long continued, is Stricture. Gonorrhoea implies a certain virulent or specific inflammation — this is its essential nature, — the ultimate tendency of which is to destroy the elastic prin- ciple with which the urinary passage is naturally en- dowed, and in this consists Stricture. Whatever shortens the duration of a Gonorrhoea, therefore, lessens the chance of a Stricture. Now, Injections shorten the duration of Gonorrhoea, — they therefore prevent Stricture. If another argument were required, I might adduce the fact that Injections are used and recommended by the greatest surgeons in the world. This, however, is quite unnecessary, — it is enough to state that, although inter- nal remedies alone will sometimes cure a Gonorrhoea, yet they sometimes totally fail; also, that in those cases where internal remedies are sufficient to the cure alone, that cure can be accomplished far more safely and certainly and in * A less than half the time if aided by Injections. It would therefore seem superfluous to say another word upon the utility of Injections, — it now only remains to show then proper use. Injections should not be used in the very early or in- flammatory stage of Gonorrhoea ; and even when this is past it is better to begin the cure with internal medicine, and continue for a day or two, before resorting to Injec- tions. After this you may use them safely and very ad- vantageously, few Gonorrhoeas can long hold out against their proper use. Injections should not be used too strong. It is no dis- advantage if they give a little tingling sensation, but if it amount to heating pain their strength should be reduced by adding a greater portion of water. It is net proper, either, to increase the strength of an Injection to any great degree, but rather, if it seems to do no good, to change it for another. So if any one has been useful, but after a time should seem to lose its power, it would be bet- ter to change it for another than to increase its strength. Injections will sometimes lose their good effect, and for this reason several recipes are given for them. Indeed, under any circumstances it is better to change an Injec- tion now and then — the part becomes accustomed io the peculiar stimulus of one alone if long continued, — the dis- ease is sooner baffled and destroyed when one correcting stimulus is exchanged for another. It is better therefore to change an Injection ; you may return if you please to the one you used at first, if that agreed, onlj change is now and then — keepiDg most to that which best agrees. Injections are chiefly mineral ; there is a great variety of them, but they all act pretty much on the same principle ; some however are better than others ; the most useful and most generally employed are the Sugar of Lead, the White Yitriol, the Alum, the White Vitriol and Alum combined. Laudanum is often added, especially when it is wished to allay irritability in the urethra or to prevent the irritation these chemicals sometimes cause. It should be recollected, always, that it is not so much the strength, as the effect of change of Injection ihat is here insisted on. The Blue Vitriol is sometimes used for Injections, but it is apt to dis- agree — irritating the passage, giving pain and increasing the discharge. It is, however, sometimes excellent on this very account — when a discharge is becoming stationary, getting neither better or worse with the other Injections, this perturbing effect is often useful, and, after using it a few days and then returning to the other, you will find an evi- dent improvement immediately takes place. Catechu, Tannrin, Sulphate of Morphia, Acetate of Zinc, Tahnate of Quinia, Iodide of Iron, &c, &c, are used as- Injections ; but these require experience and skill in their management : indeed, more depends on the skillful manage- ment of the applications in form of Injection than upon the particular preparation used — this is especially true in the instance of Gonorrhoea. Injections, to secure their greoi utility, require attention to the manner and frequency of using them. Many times I have heard it said, " The Injection does no good," when I have found upon inquiry that it had not been made to enter the urinary passage. Of course it must then fail. To use an Injection properly it must pass up a certain distance. No matter how much further, but it must go up at least several inches, and it should be kept and retained there for a minute or two, by pressing the top of the penis with the thumb and finger. The sensation an Injection gives is quite enough to tell whether it has properly entered — it is as if you wanted to pass out urine ; but the proof of it is, that a teaspoon-full or so squirts out again when you let go your thumb and ringer. To insure an injection running well up the passage it is also necessary to hold the syringe firmly enough into the ori- fice to prevent any escaping that way. With respect to the repetition of their use, this too is an important point, — much depends on their regular frequent repetition. An Injection should be used six or eight times in the twenty-four hours : every two hours or every hour and a half if you please, provided it does not irritate or pain ; but certainly not less than I have stated. The common syringes sold for using these Injections are often much too small; this is particularly the case with what are called the pp syringes; and the nose or spout is also made much too long, passing half, and even an inch or more into the passage, which proves a scource of irrita- tion to that part. A syringe should be chosen, therefore, with a very short spout, and it should hold about or nearly half an ounce of liquid. The preceding remarks relate exclusively to the reme- dies in common use for the cure of Gonorrhoea. But, it was mentioned, there are other medicines now and then required — these are, chiefly, the common remedies in use for abating pain and inflammation. To make this little book complete, it is necessary here to enumerate these, and say a word or two on the dose and proper use of each. Lotions. These are often very useful, and are generally employed to assuage inflammation, as, for instance, in the case of swelling of the prepuce, or of the penis itself, in swelling of the testicle, &c. They are always used externally, and ap- plied by means of rags soaked in the liquid and laid on or wrapped round the inflamed part. The manner of making and applying them will be found in Chapter in, Note. Cooling or Diluting Drinks. These reach the urine through the same course as de- scribed at Plate iv. They are useful in any case, and, where there is much inflammatien, with heat in micturition and high-colored scanty urine, they become very necessary. When they are required it is important to know what are the best, and how to make them. But it sometimes hap- pens a person is so circumstanced that he cannot procure these — the request to have them prepared would lead to inquiries as to what they were wanted for. To such there- fore it will be satisfactory to know that they can be done without. The softening mucilaginous qualities of which they are composed, certainly have their use, but this is no- thing compared with their diluting quality — depending en- tirely on the water in which they are dissolved. If, there- fore, you take a watery drink of any kind, as common water, the end is answered — that is, if you take plentifully of it. A near approach to these mucilaginous drinks, how- ever, can be easily and pleasantly made. Take an ounce or more of Gum-Arabic, in large lumps, in the waistcoat pocket, and consume it during the day in addition to plen- tiful drinking, by taking a lump into the mouth every now and then ; or Jujube Paste may be used instead of Gum Arabic ; it is a very pleasant thing, and gives to the simple water the softening effects of the various drinks, viz. : Flax Seed or Slippery Elm Tea, Barley Water, &c. Purgatives. Next to bleeding, purgatives form the most active agent in reducing inflammation. Opium. It is a valuable medicine under many circumstances, and is sometimes required in the accidental symptoms of Gonorrhoea. Senna and Salts is an excellent purgative medicine, either alone or taken in the morning after any pill the night before. Take one ounce, or about a handful of Senna leaves, pour on it a pint of cold, soft water, put it on the fire — taking care to remove it the moment it boils — stand on the leaves till cold — then strain off, and to the liquor add one ounce of Epsom Salts, or two ounces of Rochelle Salts. A tittle bruis- ed ginger boiled with the leaves prevents griping. Dose a large wineglass- full and repeated every half-hour or hour till it operates. Jalap and Calomel. — Fifteen grains of the former and five of the lat- ter, taken in sugar or molasses. A larger dose is sometimes given. Epsom Salts and Antimony. — Dissolve two ounces of Epsom Salts and two grains of Tartarized Antimony in half a pint of water, and take a wineglass-full of it two or three times a day, or as often as may be necessary to keep up a moderate degree of purging. Epsom Salts is a good cooling purgative ; an ounce is the usual dose, taken in water. This is the purgative that most people take on finding they have got a Gonorrhoea. It is not however the best ; for much of that quantity of salt passes through the bladder — adding to the saline ir- ritating quality of the urine, and thereby increasing the scalding pain in urinating. It is better to take one of the other purges above, but this will do if no other is at hand. It is not generally known that a very small quantity of Epsom Salts, if taken in a larger quantity of water, will act more pleasantly, certainly and effectually than a larger dose in the usual quantity of water. A teaspoonful for instance, in a tumbler of water, in- stead of an ounce in a teacup-full of water. Also, by repeating this weaker solution of salts it is a very cooling and proper medicine in a hot and feverish state. But the best of all medicines for cooling and reducing the system is the combination of Epsom Salts with Antimony just men- tioned. Seidlitz Powders is a pleasant way of taking a mild dose of saline medicine. COOLING, OR DILUTING DRINKS. BaPvLey Water. — To make this properly, take a teacup-full of pearl barley, boil it a few minutes, then throw away this dirty water, and add to the pearl barley three quarts of fresh water, and boil it down to two quarts. Some add a few figs or a little liquorice root towards the end of the boiling. Dose, a tumbler-full as often in the day as possible. Flaxseed Tea. — Take of whole flaxseed (not of flaxseed meal) two ounces or three or four table-spoons full (there is no occasion to be very exact in quantity) and add to a quart of water, which is to stand simmering by the fire for an hour or two — then strain and, if more agreeable sweeten it. Let at least this quantity be taken as common drink during the twenty- four hours. Alkaline Drinks. — Another excellent remedy to abate the pain and heat in making water is the Super-Carbonate of Soda. Procure an ounce of this, and dissolve one quarter of it in a quart of common tea, or in plain water : it may be sweetened. This quantity should be taken during the day. Or, the same quantity of Soda may be added to the barley-water or flaxseed-tea, which would increase their soothing effect. If these cannot be had, a little Gum- Arabic or Jujube Paste may be con- stantly kept in the mouth — remembering to drink frequently and freely of water. Soda Water is also a good remedy and resembles the Alkaline drink. It must however be that made from the Soda powders, and not that drawn from the fountains, which contains no soda and is merely a pleasant aerated water. A s v. IF i «9 <3 CHAPTER III. On the Accidental Symptoms of Gonorrhoea, viz: — Excessive pain and heat in making water : Swelling qfthePrepuce, — Phymosis and Paraphymosis; Frequent and painful Erections, — Chordee ; Swelling of the Glands in the Groin, — Bubo; Swelling of the Testicle. The nature of these Accidental Symptoms has been sufficiently explained, in the first Chapter; to avoid use- less repetition I shall therefore at once proceed to de- scribe their treatment and cure. Excessive pain and heat in making water. This is nothing more than a higher degree of the first or inflammatory stage of Gonorrhoea which has been al- ready noticed, but which must be subdued before the remedies for stopping the discharge are entered on. The means of reducing inflammation are, — purging, low diet, rest, and the freest use of diluting drinks, for which di- rections are given elsewhere, and Notes 1 and 2. You cannot make too free a use of diluents. The burning pain arises from the saline urine passing over an inflamed and irritable passage. The urine itself is loaded with salts — it is like brine; if, therefore, you dilute it with one of the cooling drinks, or even with simple water, it is easy to imagine how its irritating property must be di- minished. Sooner or later by the means above directed, this heat and pain will considerably abate, and then, and not till then, can you safely proceed to lessen the discharge Swelling of the Prepuce. The Prepuce (called also the foreskin) will often swell prodigiously, but this, of itself, is of very little conse- quence. A soft rag wet with brandy and water, or any of the Lotions given below, Note 6, and wrapped about the part, together with a dose or two of purging pills, is all that is required. The rag should be wetted often. It is of some advantage too if the penis be kept upright, which is easily done by pinning or fastening it to a band- age around the waist But the swelling sometimes is so great that the pre- puce cannot be pulled back from over the head of the penis, — this condition of it is called a Phymosis; — and sometimes again, when it is pushed back it cannot be drawn forward, — this is called a PGraphyynosis. Now both these states are of great consequence, particularly the latter. In the first, Phymosis, the chief thing to look to is NOTE Lead Lotion — Sugarof Lead a quar. Cooling Lotions. * er + of an ounc , e > S r oft water °™ ^ £ a teaspoonlul of vinegar should bt Evaporating Lotion. — A quarter of first put into the water: used as the a pint of Alcohol (brandy or other spi- above. tits may be substituted) in three quar- Evaporating Lead Lotion. — Sugar ters of a pint of water. The best way of Lead a quarter of an ounce, Alcohol to use it is to apply a fold or two of a quarter of a pint, Water three quar- linen upon and around the part, and ters of a pint. The Sugar of Lead, keep this wetted with it. The part with a little vinegar should be dis- should be otherwise covered up as lit- solved in the alcohol before adding the tie as possible. water ; used in the same way. cleanliness, and here a Syringe, either a common one or the pocket Syringe particularly described at page 43, will answer, is of the utmost use in washing out the humors that collect beneath the prepuce, and which, by becoming acrid and offensive, greatly increase the malady. It is necessary therefore to inject some proper fluid un- der the prepuce several times a day. Anything that will wash away these humors is better than nothing, so that warm or even cold water may be used; but the best thing for this purpose is a lotion made of the Lead, in- jection powders, or the lead Lotion in Note for these are cooling and healing to the parts, as well as cleansing. The Paraphymosis is still of more consequence ; in- deed you should lose no time in endeavoring to reduce it, that is, to bring the prepuce forward again over the head of the penis. With this object you proceed in the fol- lowing w T ay : Take hold of the head, which is always very much swollen, with the fingers and thumb, and steadily press it ; gently increasing the pressure in order to squeeze back some of the stagnant blood and lessen its size. It is better if you first hold the hand in very cold water. Immediately after thus diminishing the size of the head, apply the tw T o thumbs to it, and grasping the prepuce w T ith the fingers, steadily push back the head wiiile you pull the prepuce forward. A little force may be necessary, but you will almost always succeed; if not, the only thing a surgeon can do, would be to cut the skin on each side, where it is tightest, and then it will easily pull over ; this might be done with a sharp pen-knife or razor, after this applying a common poultice. In both these cases, of course, it would be proper to live low, keep as quiet as you can, and purge freely. Frequent and very painful Erections of the Penis. This is what is called Chordee, and a very painful thing it is. I have already pointed out its nature in the first Chapter, Plate it occurs particularly at night — the penis often being quite crooked at these times. When Chordee is disposed to come on, it cannot always be pre- vented entirely, but it can always be relieved and ren- dered tolerable. Further, a Chordee once come on, it is often the last symptom to leave the patient. The best way to prevent a Chordee from coming on is to prevent inflammation, by rest, purging, and low diet ; the best way to relieve it when it has come on, is to take two or three of the Anodyne Pills, which are probably the best, or any other in Note at bed-time. After a few nights, see if you can leave them off, but if the pain comes on again, return to them. With a view also of relieving the inflammation of the penis, on which this NOTE —the dose fa from two and a half to ten oputes. e raiD8 - Opium Pills. — Gum opium one grain, made into a pill. Laudanum. — Of this the do*e is from five to thirty drops, in a little water; to be repeated until relief is obtained. Dover's Powder is given to assuage paiu— it is a soothing and fever medicine symptom depends, it is a good thing to immerse it in a basin of hot water for a quarter of an hour on going to bed. and afterward to wet a soft rag with brandy or vine- gar and water, or common water, or one of the Lotions in Note and wrap it round the penis. Some contrive to have a bottle of cold water near the bed, which they hold between their legs whenever it awakens them. Swelling of the Glands in the Groin. This is of less consequence in Gonorrhoea than in Ve- nereal disease ; — it is a very rare thing in a Gonorrhoea for these swellings to form into matter and break 5 as they do in Venereal. Brisk purging,f as much rest as pos- sible, and at night, a rag wet with brandy and water, or vinegar and water, or any of the Lotions just named, especially the third, laid on them, is all that is required ; under this plan these swellings almost always subside. I have indeed sometimes seen them form matter and break, but it has always been owing to the constitution rather than the Gonnorrhoea. In such a case, should these tumors threaten to form matter, leeches would be proper and desirable; or, which may be very much de- pended on, a small blister of Spanish fly about the size of a dollar piece. Secure it over the swelling at bed-time, and remove it in the morning, dressing with a bit of rag spread with lard ; it may be repeated two or three times, or at once followed by the Lotion. But do not at any rate omit the purging Or sometimes, if very incon- II venient to get the blister, the Liniment in Note 9, p. 71, may be used ; it should be well rubbed in — till the skin becomes quite sore and red — once or twice a day. Swelling of the Testicle. When this complaint happens, it generally begins about ten or fourteen days from the commencement of the dis- charge, but it may occur at any time. At first there is an uneasy feeling about the part which you might judge to be the situation of the neck of the bladder — just behind the Scrotum (the purse). Then there is a swelling of the back part of one of the testicles — it is seldom both are affected at once, thongh one may be after the other — frequently with great pain, and fever. From the moment a testicle is threatened by these symptoms, give up every means for the cure of the Gonorrhoea and turn your whole attention to this single circumstance. In the cure of this affection, the first thing to be re- commended (when it can be done) is rest, and resting on a bed is preferable to any other. The next, to support the testicle by means of a suspensory bandage, which may generally be obtained at any apothecary's store. If you have not this at hand, it may easily be contrived. — Make a bag of soft linen, large enough to hold the swollen parts, and then sew or pin it to a bandage or pocket handker- chief round the body. If the testicle is suffered to hang by its own weight, this alone will prevent its cure and greatly augment the pain. Next take five or six purgative pills. Frequent and repeated purging is a powerful means of relieving this disease, and this may be followed up either by repeating the pills, or doses of Epsom Salts, or Senna Lotions also are of great use, and the best of all is the third one in Note but any of those will do, applied by keeping a soft rag, and the suspensory band- age, constantly wetted with it. Bleeding by leeches is exceedingly useful where the pain and inflammation are great, but many persons are placed in such circumstances as not to admit of their use. There is, however, another way of taking blood from the part, which might be resorted to in very urgent cases, or might be practised at sea, where leeches are not always to be had — it is as follows: t Stand before a warm fire and pull up the scrotum so as to put the skin on the stretch ; you will then see several veins of a blue color: — Take a lancet or very sharp pointed pen-knife and puncture five or six of them : — then, with a sponge and warm water, bathe the part, and you will be able to get more blood than by leeches, and with far less trouble and risk of exposure. The bleeding ceases on laying down; if not, applying fold water will soon stop it. Sometimes, even under the best possible treatment, great pain and inflammation will continue, and you are under the necessity of taking opi- ates. Forty or fifty drops of laudanum may be taken at bed-time, followed by a purgative draught in the morn- ing. The best form, however, of opiate medicine is, if it can be procured — fiifteen grains of Dover's Powder, with two of calomel at bed-time. This is as far as I would advise any one to go on his own judgement. In ver) many cases these means will stop the progress of this symptom, and indeed remove it; but, on the other hand, there are some cases in which it will not ; the pain goes on and is attended with fever and perfect inability to go about. In this case I would advise, if posible, to call in medical assistance ; but, in many cases, this is quite im- possible : you may be at sea, or in the country, or where you cannot obtain this assistance, and therefore I will pursue this subject and describe the best measure to adopt in such a case, in Note NOTE If rest, low diet, purgative medi- cines, lotions, and perhaps leoches to the p:irt, (Jo no:, succeed iri lessening the pain and inflammation, then copious ^deeding should beje>oited to Indeed bleeding would be proper in an}' case, but we do not always have recmrse to it, hoping to succeed with the moans be- fore mentioned. From one to two pints ofblood may be tal- en from the aim and repeated if not successful in allaying the pain, swelling, and fever. At the same time large doses of Tartarized Antimo- ny should be taken. Eight grains may be dissolved in lv cet, anothereminentand practical man, " in the few instances that have come under my observation, is of the most violent and intractable description, and has produced the total destruction of the organ of vision, in the space of two or three days, notwithstanding the most vigorous employment of general and topical bleeding, and other antiph- logistic means." To the truth cf this 1 can attest, upon the ground of my own experience, and I judge it therefore exceedingly desi- rable that persons should be aware of the dangerous nature and rapidity of this complaint, that they may not be induced to trifle away the only chanco of cure, for it is on the prompt and decisive treatment in the early stage alone that the invaluable sense of sight depends. to place j and thirdly, that it was the consequence of stop- ping the discharge of Gonorrhoea too suddenly. Respecting the two latter explanations, these certainly are possible but very doubtful causes. With regaid to the former, that is, inoculating the eyes by applying Go- norrhoeal matter to them, this, beyond a doubt, has been known to be a cause. These facts stand upon unquestionable authority, and in order that others may judge correctly and be careful on this point, I will relate an instance or two in Note With respect to the question whether or no there are such diseases as Ophthalmia from two suddenly stopping NOTE Mackenzie, on diseases of the Eye, page 844 states; "A patient was Drought to me from the country with violent Ophthalmia. This patient hav- ing Gonorrhoea, while engaged in re- moving the discharge from the urinary canal, a drop of the Gonorrhceal fluid was by mischance thrown fairly in upon his left eye, and excited the se- vere puro-mucous Ophthalmia under which he was laboring. The Gonor- rhoea stiil continued when I saw him. The inflammation of the eye subsided under appropriate means, the eye clear- ed to a degree far beyond my expecta- tions, and a considerable share of vis- ion was preserved." Mr. Allan relates the following re- markable case. "A gentleman, aged 17 years, had had a Gonorrhoea a few days, when violent inflammation of the eye, attended with a discharge similar to that from the urinary canal, burst forth. The Gonorrhceal running from the penis continuing unabated at the same time. In a few days his brother, aged 14, who never had hsd Venereal diseases in any way, but who slept in the same room, was attacked with a similar Ophthalmia in both eye6. In ad dition to my own attendance Drs. Munn and Mr. Js. Beil, of Edinburgh, were called in, and, notwithstanding every means that could be devised, the elder brother lost the sight of both his eyes, and the younger brother of one. No doubt the younger used the same tow- el, or wash-hand basin, or the like " Again, the very eminent and practi- cal Astruc relates a case exceedingly in point " A young man had been ic the habit every morning of bathing hia eyes with his urine while it was yet warm, in order to strengthen his sight. Although he had contracted a Gonor rhesa, he did not abstain from this cus- tom, apprehending no harm from it ; but the urine partaking of the infec- tious matter, quickly communicated the same disease to the conjunctiva (the mucous membiaine which lines the eyelids). The consequence was a severe Ophthalmia, attended with aD acrid and involuntary discharge oi tears and purulent matter, but which yielded to the same remedies which removed the Gonorrhoea." the discharge of Gonorrhoea, and Ophthalmia arising from the constitution imbued with Gonorrheal disease, it is not necessary here to determine; many persons think there are, and I have no proof to offer that it is not so ; more- over, the cases we occasionally meet with here and there in the various periodicals would seem to corroborate such opinion. As 1 have already said, however, if there real- ly be such cases, they are very rare, and I have no doubt that many of those cases of Ophthalmia, as well as Rheu- matism, which are there related, have been diseases which happened to occur at a time when the patient was labor- ing under a Gonorrhoea, and had really no other connex- ion than their accidentally occuring at the same time. But, as I have said, as some persons think otherwise, I will give in the following Note, , (principally for the perusal of medical men) the peculiar treatment which such persons have adopted who have thus thought. NOTE of the bougie may perhaps produce the eflect so much desired ; for any Treatment of those cases of Oph- stimulus applied to the lining mem- {halmia which are supposed to arise brnne of the urethra, provided it be from too suddenly stopping the dis- of sufficient activity to determine charge — Of comse this kind of an irritation and a secretion of mu- Ophthalmia includes only that in cus, may produce a running similar which the dL-ehame is stopped — to Gonorrhoea. If this plan is adopt- On this subj-ct Mr. Mackenzie, ed the Bougie must be retained in (page 376) observes, "The only the urethra for several hours at the pointln which the treatment of this time, till the effect is produced." 0.?pthal.mia differs from the former With regard to the treatment of is in the attempt, so much recom- those cases of Ophthalmia which are mended by some authors, to restore supposed to arise from the constitu- thesuppries(;d discharge of the ure- Hon being imbued with Gonorrhoea! thra. This i9 to be done by intro- disease— Scarcely any thing is re- ducing a bougie into the urethra, commended which differs from the covered with some of the purulent treatment of a similar state of Oph- dischargefrom the eye, or with G >- thalmia from cold or any common noirhoeal matter from another sub- cause. jfcet. Even the simple introduction The discharge from the urinary I fear I shall incur blame for having carried out this note to so great a length, but the consequences of delay or any misconception of the nature of this malady, es- pecially that of inoculating the eye with Gonorrhoea! matter, is so dreadful that I cannot possibly omit it. It passage may be present, or may not ; and, it is worthy of remark, that w i^n it has come on, not hav- ing been ubstrved when the Oph- thalmia b'gan, ii many cases, the occurrence of discharge from the urethra has made no difference in the symptoms of the Ophthalmia. Notwithstanding this, however, a celebrated writer upon Gonorrhoea (Swediaur) advises "the use of the Bougie for a couple of hours," with the intention of bringing on discharge. This kind of Ophthalmia too, is less severe than the former, or that wising from matter applied imme- diately in the eye ;— it is of a more chronic nature, and begins in the eyelids in the form of a little ulcer from which yellowish matter ex- udes : which in theformer kind, the whole surface of the globe of the eye and inner surface of the lids are affected with redness and swelling; the matter discharged also is pro- fuse and frequently acrid and ex- coriating to the outer lid and sur- rounding skin. Abemethy, in his surgical Lec- tures, calls it irritable Ophthalmia, and ascribes it to an irritable state of the constitution in which the bowels and digestive organs deeply participate. When this state of the constitution is brought on, either by the Gonorrhoea or the means adopted to cure it, he states that either this Ophthalmia or Rheuma- tism may occur ; or that they may both occur, alternating with each other, even alternating with the dis- ease of the urethra, and that the proper way of treating it, beside sooihii g applications to the eye, is to give five grains of blue pill every night and a dose of castor oil in the morning, keeping the patient on a strict spare diet. In support of this opinion hegiv s thefollowingcase. A gentleman who had been anx- iously endeavoring to get appointed commander of a frigate while in the country, at length received instruc- tion from the admiralty to take command of a frigate then lying at Falmouth. He lost no time in placing himself in the mail coach for London. Just before he left Edinburgh he had caught a Gonor- rhoea. In January his eyes became inflamed ; and when he reached London, he had a violent Ophthal- mia, with purulent discharge. He was in a dreadful state both of body and mind,— could not bear the light, and had great pain in his eyes. In this state he consulted M. Abeme- thy. He stated also that when the dischargefrom the urethra stopped, the eyes became bad, and when the eyes got well the Gonorrhoea re- turned. In this state Mr. Abeme- thy directed him to keep quite in a darkened room, to wash his eyes frequently in the course of the day with tepid poppy water, to take five grains of blue pill every night, and a dose. of castor oil next morning, and to live strictly low. " During the first six days he mended very slowly, and not considerable, but on the seventh day, when Mr. A, called, he found the patient sitting up in his room, the window unco- vered and his eys almost well. Mr need not, however, incommode the general reader, for being given in a note he can easily pass it by, while, should he be threatened with this formidable turn of the disease, he would derive important advantages from its perusal. But, indeed, if by the prompt and decisive means which are urged in every instance of this kind, I should be so happy as to save the sight but of one indi- vidual, I would willingly incur the blame of every other §2. Gonorrheal Rheumatism. With regard to this, I myself very much donbt its ex- istence ; for those however who may think otherwise, I have chosen to insert the following, also in the form of a Note, ( ) A. expressed his surprise and asked how this change had so suddenly happened, to which he answered, that he had had a number of very copious stools in the night, and that his complaints h .d left him. It seemed to be a sort of critical secre- tion from the liver and the whole of the alimentary canal, followed by an almost immediate removal of the irritable inflammation of the eye." Mr. Abernethy also takes occa- sion to warn persons against mis- taking this Ophthalmia arising from an irritable state of the constitution and digestive organs, for that fol- lowing inoculation, or t;e immedi- ate application of Gonorrhoeal mat- ter to the eye, for the means recom- mended for the first would add to the irritability and debility of the constitution, and increase the dis- order. His words are, that, " if the surgeon is frightened at this irritable Ophthalmiu, supposing it to b? one of the dr.-adful cases in which the eye is clapped, and pro- ceeds to bleed and purge the patient seveiely, he will only make the matter woise. Moderate bleeding," he s-ays, " may be useful, but the chief object is to fittend to the pa- tient's health. No means are so likely to be useful as setting the digestive organs to rights and send- ing the patients to the country." NOTE On the treatment of Rheumatism^ from tJie same supposed GonorrhceaJ, taint of the constitution, but little can be recommended in addition to what i6 approved in Rheuma- tism from other causes. The his- tory of a case of this kind will best convey what is meant by this dis- ease. M Major , aged 26, eontracted Gonorrhoea. In a fortnight he was seized with a swelling of the testi- cle. When this abated, pain and swelling of the right knee began; on travelling in an open carriage on the second day the other knee, foot, and joint of the great toe, swelled. The pain was excruciating. He then came under the care of Sir Henry Halford, (the king's physi- cian) but no treatment seemed to po3.^e? any power in removing the complaint. Now, in addition, his right eye was suddenly attacked by a very violent inflammation which threatened destruction to the organ. He then gave up medicine and went into the country for the restoration of his health, and after being there f<>r about three weeks, the Gonor- rhoea again increased without any abatement of the other symptoms. The joints so stiff and swollen he c uid h iidly crawl about. Warm bai hing and a residence by sea were recommended. From the former he experienced little apparent bene- fit, but alter a tedious convales- ence of two years, he found him- self able to join his regiment in Spain.— He recovered the use of hU limbs and had no return of his complaint, though exposed to ma- ny hardships in the campaign of 1812, &c. &c. Two years after, he again contracted Gonorrhoea, a very violent one. In a fortnight the discharge began to abate and vio- lent inflammation attacked the great toe and foot. The disease then proceeded to the knees. As the violence of the inflammation of the knee abated, the left eye was attacked by violent Ophthalmiaand excited great alarm for its safety. It seemed to be deep-seated in the coats of the eye. The sight of the right eye was also impaired. At the end of two years more, his knee joint was stiff and much swollen, and the urinary passage was all the time subject to returns of Gonorrhceal discharge." 1 have given (lis case to show how possi- ble it ta for Rheumatism to occur, when a patient is affected with a Gonorrhoea, and how easy it is to suppose it is the effect of Gonor- rhoea, merely because it happened at such a time. But after all I see nothing in this case that differs from Rheumatism from common causes, and the present differs in no important point from others I have seen, which have been thought to arise from Gonorrhoea. Rheuma- tism is frequently a tedious com- plaint; its peculiarity is, shifting from place to place, and in this way it will sometimes assume the char- acter of inflammation of the eye, then of the joints, and will also sometimes alternate with disease of the urethra. Respecting the treatment of Gonorrhceal Rheuma- tism, if there be such, I am not aware of any particular in which it differs from the treatment of Rheu- matism from any common cause. As it is possible however that some connexion may exist between the inflammation of the urethra and in- flammation of the eye ; in cases of the latter kind, occuring when the patient has Gonorrhoea at the time, I think the recommendation of Swediaur, to employ the bougie, is a safe and justifiable remedy. CHAPTER V On Gonorrhoea in Females. There is no difference in this disorder in females but what arises from the difference in the organs which are the seat of it. Generally speaking, however, the in- flammation attending is more diffused ; in some cases it extends to the lower part of the belly, which makes it painful on pressure; also, the urinary passage being shorter, it is more apt to produce irritation in the blad- der than in males, so that there is a greater inclination to make water. There are no ulcers in this disease, al- though the discharge is sometimes so irritating as to ex- coriate or take off the skin. There is almost always a swollen state of the external parts. There are, however, some curious circumstances relating to this disorder in females which should be known, — the following are of this nature. Generally speaking, the disease is milder in women than in men. Also, a female may have a Gonorrhoea without her knowing it. This happens from the complaint being of a milder character, and from her not discriminating be- tween this disease and certain slighter forms of discharge which many females are subject to. It is most likely to occur in women of unrestrained intercourse, as such per- sons generally have the slightest forms of this disorder. The same female may give a Gonorrhoea to ont per- son and not to another. This arises from the habi> and character of the person himself. — If he has pursued h life of free and unbridled intercourse, he is much less liable to receive infection than a fresh and healthy person of a contrary character; the latter will frequently take a Gonorrhoea from a female who has only a slight, gleety discharge, whon the former would escape it. Again, a female may receive a Gonorrhoea from one person and give it to another without having it herself. This may appear strange, but it is a fact; — it happens in this way : A female has an interview with a person hav- ing a Gonorrhoea, and soon after sees a fresh and healthy person ; this latter comes in contact with the infectious matter before it has had time to engender the disease, and removes it ; the consequence is that he takes the Go- norrhoea and she escapes it ; it is an incident which often leads to very puzzling surmises. In the last place, — a female may always know, or at least have reason to suspect, she has an infectious dis- order, when she has lately had a Gonorrhoea and a dis- charge remains, greater, or in any way different, from what she was accustomed to before she had the Gonor- rhoea. • 6 The treatment of this disease in the female differs in several important points from its treatment in the male ; — viz : there is much more occasion for the use of cool- ing drinks, especially those containing soda, — the use of the tepid bath, or warm fomentations is more necessary, — the appearance of her periodical illness complicates the case and demands great caution in the management of the remedies at that time. And again, with respect to the internal remedies, their influence over the disease is very much less ; though, any of those mentioned already may be taken, and sometimes are really used with advantage. Now, just as in the male, the first or painful and in- flammatory symptoms must be subdued before means are taken for stopping the discharge ; — this will be done by repeated purgative doses, and the free use of diluting drinks, together with low diet and rest. When there is much ex- ternal heat and inflammation, fomenting by cloths or flan- nels wrung out of hot popy-head tea is very useful. Four or six popy-heads should be bruised, and boiled in two quarts of water for a few minutes, and the liquor kept hot while used. Having then abated the pain and inflammation, and per- haps also taken some internal medicine for a few days, In- jections are at once commenced with. These Injections of course must be used by means of a female Syringe, which can be procured at any apothecary's store. With regard to the Syringe for Females in common usa, this is a very poor contrivance. Its great fault lies in its not enabling the patient to retain the injection in the passage ; it allows it to run away and escape immedi- ately, even before it can have reached the whole length of the passage, — thus the part of the inner surface that most needs the application is often entirely untouched. In order to have the full effect of an Injection, the Sy- ringe should hold enough to fill the passage, and when filled it should be retained there. My own Syringe, (a representation of which will be found on this page) is made to answer both these purposes, as many have happily experienced; for, after using the common Syringe for a length of time to no good purpose, they have succeeded with this contrivance to their fullest wishes. DR. RALPH'S IMPROVED FEMALE SYRINGE. With these remarks, I finish the subject af Gonorrhoea and Gleet in Females, and when it is considered that so long as any discharge, remaining after Gonorrhoea, exists, so long there is a possibility of spreading the disorder to a second person, a sufficient reason will be seen for laying so great a stress on curing Gleet at once, and doing so by In- jections, for it scarcely can be cured in any reasonable time without them. * Manufactured by Mr. Liese, 102 John Street. CHAPTER VI On Gleet. — Its Nature and cure. A Gleet is almost always the consequence of a badly managed Gonorrhoea. Instead of following up the cure of that disease by the means which have been so partic- ularly dwelt on, viz. Injections, the discharge is suffered to go on from month to month, and the effect of this is to entail a permament disordered condition of the parts affect- ed and which generally then goes under the name of Gleet, Weakness, &c. It is important to understand the nature of this malady as well as how to cure it, especially as a very serious error respecting its infectious nature, prevails with many. It is a very common thing to hear it said that a Gleet is not infectious ; but this is very wrong, and often leads to great trouble. Virtuous and unsuspecting women are unintentionally involved in this complaint in consequence. A person who is about to marry, for instance, may not have had Gonorrhoea for six or nine months, or longer ; but a slight discharge — so slight indeed that he has scarcely observed it — may have continued all this time. But he does not dream of its infectious nature until the saddest consequences show themselves. So, also, unfor- tunately, does a similar cause of unhappiness frequently occur in those that have been abroad or from their family for a length of time. Indeed, the consequences of this error are so very serious that it merits any pains and trouble to set the matter in its own true light, and per- haps I cannot do this better than by giving a case or two as related by Sir Astley Cooper. On this subject, then, Sir Astley observes, — " Gonor- rhoea, when neglected, sinks into a Gleet, and is known by the change of the color of the discharge, and the pain attending the inflammatory stage ceasing. In this state, is the discharge infectious or not ? I doubt myself whether a Gonorrhoea ever loses its power of causing infection as long as any discharge from the urethra re- mains, and I will give you my reasons for this opinion. A married gentleman went to Lisbon from this country, [England] and whilst at a distance from home, departed, as too many do, from the path "of virtue. The Portu- guese lady with whom he cohabited gave him the Clap. He returned to England, and, after the expiration of five months and three days after first observing the Gonor- rhoea, he called on me, and asked whether he might re- turn home with safety to his wife. He said he had a little discharge, and wished to know, if, after having it five months and three days, it were possible for it to be infectious. I replied — ( Certainly not ; you may go home, tnere is no danger of your giving it to your wife.' He T*«nt home, and unfortunately give his wife a severe O.iap. I attended both the parties afterwards, aud was fiJtreraely sorry for what I had done ; — but I thought, at the time I gave the advice, that a Gleet was not infec- tious. But I think differently now, — and believe that, after a continuance of several months, the discharge is infectious." Another instance. — " A gentleman from the north of England, who had been recently married, came to me and said that he had communicated a Gonorrhoea to his wife. Shocked at such an occurrence, I said, ' How could you think of acting in such a manner V ' Why, sir,' said he, ' for fourteen months prior to my marriage, I had a Go- norrhoea; I made various attempts to get rid of it, and had a variety of advice about it, but a yellow discharge al- ways continued. I was told by every body that it was not infectious, and not until after such repeated assurances did I get married ; the consequence, however, is, that my wife has a severe pain in making water, and a copious dis- charge.' I visited her, and found her in this state ; she was some time under treatment before she quite recovered. From what I have seen, I do hold that a medical man is not warranted in saying that a discharge of a Gleetykind is not infectious." On these two cases thus faithfully related, then, every person may be able to form his own opinion on the infec- tious nature of a Gleet ; I think they are sufficient to make every reflecting conscientious person take care how he gives advice in such a case, particularly if his patient is a married man. Indeed, it is from this error, or from a total indifference as to its consequence, that we have so many cases of Gonorrhoea, — they are twenty to one com- pared with cases of Venereal. In fact the common wo- man of the town pay no attention to a Gleet. After the first or inflammatory symtoms of a Gonorrhoea have subsided, they mix with society as though nothing ailed them. In the patients of the Hospital called the w ' Lock," in London, for instance, nothing is more common than to see the Venereal and the Gonorrhoea in the same female; but it is the Venereal which brings them there. As to the Gonorrhoea, or Gleet, they will tell you they have had that a long time, and thought nothing of it, but having got the Venereal, in the form of chancres, they became alarmed, and anxious to be cured. So also, when the Venereal is cured, they seldom stop in the Hospital for the cure of the Gonorrhoea, or Gleet, but go out again promiscuously in the town and spread the Gonorrhoea in every quarter. I do not however, after all, say that every Gleet is in- fectious, but, they are so generally, and there is no mark whatever by which it can be said that this one is infec- tious and that one is not, — this can only be known by its consequences. How serious therefore to say to any one, especially to a married man, or one about to marry, that a Gleet is not infectious. But it is incumbent also to state, that there is a discharge from the urethra, in some measure resembling a Gleet, which is not infectious. A discharge of this harmless kind may proceed from two causes which may be easily understood. In the first place, it may proceed from a little abscess which occasionally forms in the urinary passage, and breaks; and the other is, a discharge proceeding from a Stricture. Now, the nature of these two causes of discharge must be under- stood, and then a suspicious Gleety disorder will be easily detected and distinguished from either of these. First, — With regard to the discharge from the little abscesses above mentioned, it should be known, that, in the whole length of the urinary passage are situated here and there, little sacks for the purpose of secreting a lu- bricating fluid; these are called lacuna. After a Gonor- rhoea, these little lacunae are sometimes affected with common inflammation, which forms into abscesses, and when these burst and their contents are discharged, the running ceases. Now-, the circumstance by which these abscesses may be distinguished from a Gleet, is this; — the discharge from these lacunae stops entirely for a week or tw r o, and then, when another breaks, it comes on acrain, suddenly, and again ceases as before ; but the discharge from an infectious Gleet never stops ;- — it may increase, from excesses or irrigularities of any kind ; and it may decrease, so as to become very trifling, — but it never ceases altogether. This, therefore, affords a good rule forjudging between Gleet and a discharge from these abscesses in the urinary passage And next, — With respect to the discharge arising from Stricture, this will be easily detected by ^considering the symptoms proper to Stricture. For the necessary instruc- tion on this subject, however the reader must be referred to Chapter ix, on Stricture. The Treatment and Cure of Gleet. A G-leet is often a very troublesome disease to manage. If there were no other reason for saying this, I might safely infer it from the numbers who have come to me with this complaint, having had it on them, more or less, for a length of time. These patients generally state that they have tried a great variety of means, and are quite disheartened. I cannot always learn particularly what these means have been, but two important things I do know ; firsts that what- ever they have been, they have always failed ; and next, whatever has been the state and condition of their case, the means I am now about to mention have always succeeded. I think it right to premise these remarks, because it may be thought the plan I recommend is very troublesome ; it may be so : but then, I would repeat, this plan succeeds when every other means fails, — and I am quite sure no bet- ter can be availed of. In the first- place, then, I would say, that if Gleet is of recent date — that is, if the originating disorder, the Go- norrhoea, were not taken above one or two months ago> the remedies recommended for the treatment of Gonorrhoea, in Chapter n, will generally prove perfectly successful. If, however it is an affair of several months, perhaps half a year, or a year, then different measures should be tajsen and which r will now describe. First, the Internal Remedies, as the Balsam of Copaiva and the Cubeb, — these, I do not hesitate to say, are worse than useless in settled Gleet ; — not only can they never cure it, but, holding it more or less in check whilst taken, they deceive the patient and induce him to fritter away valuable time, not to mention unnecessary phy- sic-taking and loss of money ; whilst in ninety -nine cases out of a hundred, the foundation for a permanent and serious de- rangement — Stricture, is being surely laid. In the use of Injections, however, properly employed, we may place the most complete confidence ; these sometimes in conjunction with another remedy presently to be men- tioned, form a plan of treatment which no Gleet can very long withstand. Any of the Injections employed for the Gonorrhoea may be used. But there is another very useful addition to Injections in the cure of Gleet : and this is the Bougie. I should advise it to be used in every case that had existed three months (from the originating Gonorrhoea) or more. You may then begin with the Bougie and Injections both at the same time ; or commence its use only when you have tried the other plan without proper success. Other remedies, and indeed several very different modes of treatment, are occasionally required in those old and ob- stinate cases of Gleet that we frequently meet with ; but they are mostly of a character demanding great judgment and experience in their application, and could not with pro- priety, or even with any utility, be entrusted to public or non -professional use. CHAPTER VII On certain diseases Resembling Gonorrhoea in some re- spects, and which are frequently mistaken for it ; but which, nevertheless, are totally distinct and different diseases. Nothing can be more valuable to those concerned than to know how to distinguish between real Venereal dis- eases and diseases which are not Venereal, but which re- semble it. Those into whose hands this little book may fall will be enabled to do this effectually, and will thus escape the advertising schemes of a set of people the most unprincipled and detestable that were ever suffered to deceive the public. These people, either from igno- rance or knavery, call every thing Venereal they may happen to see upon the sexual organs. Now, the struc- ture of these parts, in many respects, is the same as that of other parts of the body, and they are subject to the same diseases we meet with in other parts. It is a fact and one which I shall presently show most clearly, that many of the disorders these people call Venereal, have nothing at all to do with that disease. Nothing is so easy as to deceive an inexperienced person into such a belief. Knowing he has been once exposed, although it might be far too long ago to be the cause of his com- plaint, yet, if he happen to have any strange append** on these organs, he directly thinks it must be this disease. Indeed I am frequently troubled to convince them it is not so ; but Jet them go to any of the people I allude to, and they are sure to be confirmed in this belief. There is however another and a far more serious view to take of this deception : it is, its effects upon the mind. The money they extort on such a plea is nothing : nor is the fine and healthy constitution which they ruin half so great an evil as the anxiety and load they fix upon the mind — it breaks the spirits. In a single man, a false impression of such a kind may be of little consequence; and there are married couples, of a moral stamina so firm and unassailable, that, mutually confiding in their own integrity, no insinuation of this kind could possibly tell upon their happiness; but, on the other hand, there are others of a less confiding disposition, — those in whom symptoms so new and unaccountable, especially if ex- plained by insinuations of such a nature, would leave a deep impression, if not indeed, destroy the very basis of connubial confidence. And this is no imaginary case, nor yet a very rare one. Enjoying, as I do, much of the confidence of this city, and being known to have given much attention to this class and order of diseases, cases of this nature frequently occur to me, and, sometimes too, of great importance. This indeed will readily be ima- gined when the remarks I am now about to make upon the subject shall have been perused. The diseases which in some respects resemble Gonor- rhoea and are frequently Mistaken for it, but which, nev- ertheless, are totally distinct and different diseases, are chiefly four. These I will now proceed to notice, and will also show their proper treatment, which is always very* simple and successful. The first of these complaints occurs in men, and con- sist of, — The natural secretion of the part, accumulated beneath the fore-skin. When this occurs it becomes irritating and excoriates the inner surface of the fore-skin, as well as the head of the penis, giving rise to some uneasiness and swelling. At this time, if the fore-skin is pushed back, the parts beneath it look quite serious, — the discharge accompany- ing is offensive and considerable, — the parts swollen, — and the excoriated surface presents a red and quite angry appearance. Now, in this state, it is an easy matter to impose upon the mind the false idea of a Clap or Gonor- rhoea. Indeed as 1 have said before, it is sometimes dif- ficult to persuade a person it is otherwise. Yet, all this is a very innocent affair. To be convinced that this is not a Gonorrhoea, just look to page —observe the descrip- tion of that disease, and compare the two. There you will find that the discharge in Gonorrhoea issues from the orifice of the urinary passage, from which you may al- ways squeeze a little matter; but in this the discharge is • 7 supplied from the surface of the fore-skin and head of the penis. This is quite enough to show it is not a Gonorrhoea And that it is not Venereal, you may likewise be as certain from the fact, that this — the Venereal — begins with one or two, seldom with more, distinct little ulcers, (see Chap, xin), which are inclined to become deep instead of broad, and which discharge but very little matter, whereas, in this, the discharge is copious, and there is no ulcer at all — it is rather an excoriation of the skin than an ulceration. Now it is a grievous thing for a man to be told that he has got a Gonorrhoea or a Venereal disease, and to be treated accordingly, under circumstances like these. The truth is, this case is nothing more than a little al- teration in the secretion of certain glands situated under the fore-skin, occurring frequently in those who neglect to wash these parts, particularly in hot weather; and its cure is easily accomplished, simply by washing often in the day w T ith simple Sugar of Lead Lotion, or brandy and water, or even plain cold water — taking at the same time, a dose or two of physic. If this should happen to be ineffectual, which is rare, a little bit of lint or soft rag, soaked in one of the Lotions NOTE 2.— White Vitriol 10 grains— Tincture I otions par top Arovf of M y rrh 2 diacb^s-TLaudaniim 1 lotions for the Above drachm-water to fill a Uo-oun, e vial 1. — Sugar of Lead 15 grains — Tine- Either one of these will ofteu be suf tme of Myrrh 2 drachms — water, to fill ficieut— the first is the milder. It is bet a two-ounce vial, a few drops of vine- ter, however, to obtain both, so as to garto be added to the water before the change the application every second oi Sugar of Lead. Another is, third day. To be used as directed above in Note , and applied two or three times a day, would certainly cure it. The application is best made by laying the bit of lint over the head of the penis, and then drawing the prepuce forward over it; in this way, it remains in contact with the inflamed surfaces. The next of these diseases is of more importance ; it is one which occurs in females, and often gives occasion to many painful and unfounded fears, for it approaches, in appearance, much nearer to Gonorrhoea. It consists of,— Symptoms resembling Gonorrhoea, communicated by Females in whom no appearance of disease can be detect- ed, or who have only those complaints which are consid- ered innocent and common. This is a disorder on which I am very anxious to be plain, and to be thoroughly understood. It occurs often in those who have a discharge resembling what is called the " Whites," or " Weakness." Now the Whites is a disorder to which many females, both single and married, are subject. The discharge of it varies in quantity and appearance ; it may be much or little ; clear, or opaque and milky ; thin and watery, or thick and adhesive. In one or other of these forms, however, varying from cir- cumstances, the Whites may continue for many years, proving nothing more than a secretion of what is nat- ural to these parts, but increased in quantity or altered as above described. The circumstances which originally cause, and which vary this disease, are many, — such as weakness of these organs, — too great fullness of their vessels, — having children fast, — or too great excitement of the parts, and others. But, although this disease, the Whites, may, and most frequently does remain for any length of time without producing any corresponding mal- ady in the other sex, yet, on the other hand, it may, and sometimes does become infectious, communicating the like disease to another person. Now the object of this chapter is to show that it does so, as it were, spontaneously, — that is to say, without in- tercourse, with other, or infectious persons. With respect to the fact itself, that disease resembling Gonorrhoea may occur in innocent women, spontaneously, which is so far contagious as to affect others, I would only observe, that there are but few Physicians of much practice who have not had cases which they would be puzzled to explain on any other principle. I will here give the outline of one or two as they have occurred to me. A gentleman came, for instance, with the following statement : — Sir, said he, I have some strange symptoms of disease about me ; and such, indeed, if it were not for ay confidence in another party, I really should suspect to be the symptoms of a Gonorrhoea, for I once contract- ed that disease and know something of its nature. Well, I said, what are the reasons which lead you to determine it is not a Gonorrhoea? The party I refer to is a lady whose word I could not question : besides, I have known her long, and am quite certain that no consideration in the world would allow her to expose me to the possibility of such a malady. And further still, having mentioned these circumstances to her, she denied it firmly, and is de- sirous that some one should see her — so perfectly uncon- scious is she of having any such disease. Now on this occasion I could detect no one single symptom of disease, and what is still more worthy of remark, I learned she was in the habit of being visited by another, and who also was perfectly free from every symptom of disease. But in my Note Book I have a still more curious case, and which I think is worth relating more particularly. It is this ; — A gentleman who had formerly been my pa- tient, consulted me on what we took to be a Gonorrhoea, and at the same time requested me to see the lady, whom he had known some time, and who assured him that she was perfectly free from any such disease. I did so, and found it exactly as he had stated, she had no one symp- tom — not even a Gleet. However, we treated his dis- ease as Gonorrhoea, and though the cure was tedious, he at length got well. But, sometime after, he renewed his visits to this lady, and was again attacked with a similar disease — symptoms which differed in no other respect from the Gonorrhoea, than in their mildness. After this, however, he kept away for a considerable length of time, and, although in this interval he had interviews with other females without disease, yet, in renewing once more his visits to this lady, he was again, for the third time, attacked with all the symptoms of a Gonorrhoea. I know it may be urged in all these cases, that they occurred in females of a certain character, and therefore they might have been old cases of Gonorrhoea, degenera- ted into infectious Gleet, — a disease which continues al- most indefinitely, — is not attended with pain, — and in which there is frequently but very slight discharge — not more, indeed, than many women (and females of this de- scription in particular) are subject to. But to this objec- tion I cannot hold, for two reasons : — first, because such cases sometimes occur in women who never had a Gono- rhcea ; and next, because, if they had been cases of Gon- orrhoea, or Gleet, they would be infectious to every one alike, or very generally so. Now and then, we know, a person may have an interview with a female who has a Gonorrhoea, or infectious Gleet, and may escape ; but this is an exception to a very general rule — it dose not often happen. Likewise, that one individual is more sus- ceptible of infection than another ; but this also is very limited — the rule being, and pretty uniform it is, that, in such cases, the disease communicates to all. Here then, while a common Gonorrhoea will affect all that come within its reach, or pretty generally so, this mild disorder, while it will affect some, will as uniformly suffer others to escape. It therefore affords a striking difference in its consequences, aud from this we may infer there is also a difference in its nature. My design in this section of this work, is to excul- pate innocent and virtuous women from injurious and un- deserved suspicion ; and this I apprehend to be an object of immense importance, for the consequences of such un- just suspicions might be painful and serious in the ex- treme. Even in the limits of my own experience I have met with lamentable instances of this kind; instances too in which I am morally certain there was not a particle of truth, and in which suspicion never would have gained possession of the mind, if the subject had been better un- derstood. With this view of importance, I therefore deem it pro- per to place this fact upon the best authority in medicine which can be adduced. Now I have already shown that symptoms resembling Gonorrhoea have been communi- cated by females in whom no symptoms of the disease existed, or were ever known to exist; but these females were not to be considered exemplary specimens of moral character. And further, I have stated them upon my own experience. I will now however, show that the same thing happens in females of the highest moral cha- racter, and will show it also on the very best medical authority. Here I might refer to the great John Hunter, to Abernethy, and a multitude of others; but in that highly esteemed and learned work — Goon's Study of Medicine, — there is a paragraph on this subject, so clear, that I cannot do better than transcribe it. In the fifth volume, page 8, after speaking of other diseases attended with mucous or purulent discharge, which are now and then contagious or infectious, — such as Dysentery, purulent Ophthalmia, and others, — he says, "In like manner, Leucorrhcea (which is the medical terra for the * Whites,' in females) as we have already observed, has sometimes seemed to be contagious ; for I have occasion- ally found a kind of Blennorrhea (Gonorrhoea or Clap) produced in man, accompanied with slight pain in the urethra, and some difficulty in making water, upon coha- bitation with women, who upon inspection, had no marks whatever of luodic Blennorrhea, or Clap, and in some instances, indeed, were wives and matrons of unimpeach- able character." This, at any rate, will satisfy the mind that such a thing is possible. But, neither has my experience on this point been con- fined to females of questionable character j I have seen the same happening between husband and wife, where there was no other ground of suspicion, and where a proper and scientific opinion, given at first, would have prevented much subsequent distress of mind to say the least. I have also had the satisfaction, in many such cases, of knowing that the information continued in this little volume has been the means, not only of removing unjust and cruel accusations, but of reconciling parties and even of preventing divorce. With respect to the question, — how can a harmless se- cretion be changed into an infectious one? this I cannot answer any more than I can tell why the discharge from Dysentery, or Ophthalmia, or common Catarrh, disorders which are generally harmless, should sometimes become contagious. The structure of the membrane which is the seat of the disease in all these maladies, is exactly the same as that which is the seat of the disorder in Gonor- rhoea. It may be, and no doubt often is, from neglect of necessary washing ; and to this the habit of irregular in- tercourse may give a greater tendency, for it is not to be denied that such instances are much more frequently ob- served in women of bad habits and inconstancy, than in virtuous persons ; but this by no means proves that these are cases of genuine Gonorrhsea, nor that they do not now and then occur in persons of a strictly virtuous cha- racter. With regard to the treatment of this complaint, it is axactly that of Gonorrhoea, for which see Chapter n on the treatment and cure of Gonorrhoea. It therefore appears that symptoms very much resem- bling Gonorrhoea, and which are infectious too, may be received by cohabiting with females who do not present the least appearance of that disease ; — that, although these are more frequently observed in females of lax morality and habits than others, they are also known to occur, oc- casionally, in women of exemplary character — even in NOTE instance, in Venereal. Two general principles chiefly regulate the treat- On this subject it may be remarked ment of them all ; the first directs what- tnat the treatment of Gonorrhoea is ever abates inflammatory symptoms, if very much the same as that of other any such exist ; the second, such re- diseases affecting similar membranes, medies as supercede specific actions by as in contagious Dysentery, Ophthal- setting up an action of their own— pre- mia, &c There is no specific remedy cisely as the Internal Remedies do in in any of them, such as Mercury, for the cure of Gonorrhoea. wives and matrons whose habits, age and religion, place them beyond uncharitable suspicion ; — and, that these complaints are cured by the treatment proper in the mild- est forms of Gonnorrhoea. A third disorder which resembles a Gonorrhoea, and which happens in men, is Stricture in the Urinary Passage. Stricture, upon excitement, will sometimes produce dis- charge exceedingly resembling Gonorrhoea, but without the usual degree of pain and inflammation attending that complaint. What a Stricture is, I will take great pains to describe in a future chapter. Here it is only needful to say, it is a contraction, or a diseased condition of some part or other of the urinary passage, generally the conse- quence of a badly treated Gonorrhoea, but which often continues for a time so free from pain or any inconveni- ence, that it is not suspected to exist, and is only brought to light by the occurrence of some sufficiently exciting cause. Now, the act of sexual intercourse is a sufficiently exciting cause, and hence the disorder now referred to is frequently observed to follow quickly after it. I have often been consulted by persons who have remarked that they are quite unfortunate, for they scarcely ever are ex- posed without contracting this disease; and, what to them is most remarkable, is, that others who have visited the same female have escaped, The fact is, that this is not a case of Gonorrhoea at all, but a Stricture ; and their friends have not these symptoms, because they have no Stricture. Of course, if such a person go to an advertis- ing knave, he will tell him immediately he has got a Go- norrhoea ; and further, the medicines he may give him may probably remove the symptoms, so that he will get the credit of curing a Gonorrhoea. But, in truth, he will no more have cured a Gonorrhoea than he will have cured a Cancer; for, with purgatives and a low diet, this dis- charge generally ceases in a little while. — It would there- fore seem exceedingly desirable to have some plain and positive rule to judge by in cases like the present, and fortunately, 1 have one to furnish. This rule is founded on the time when such symptoms first appear after con- nexion. The discharge I am now speaking of, that is, when it is from Stricture, first appears within twelve or four and twenty hours after such excitement, — a period shorter than is required in the quickest case of Gonorrhoea. Now, Gonorrhoea may be compared exactly to inocula- tion. There is always a process and a certain time re- quired, in order to produce the inoculated malady. It is true that some inoculations produce their proper symptoms sooner and more regularly than others; but the usual time peculiar to each is generally known, unless delayed or interrupted by some peculiar state of constitution, and is pretty regular. The usual period for the production of the symptoms of a Gonorrhoea is the third day after expo- sure to it. This however, is sometimes delayed for seve- ral days by the causes I have mentioned ; and, sometimes too, is a little quickened ; but, as to its appearing in twelve or four and twenty hours, that it never does, and never can do. This then I consider a valuable fact, — it forma the basis of an excellent rule in practice, the use of which may be seen by the following. To a person, for instance, consulting me on Gonorrhoea, I generally put this ques- tion first : — How long is it since you were exposed? Now if he should say, why, it is very recent — it was only last night, and I observed some symptoms of it in the morn- ing ; or, at any rate, if he should state that it is within twelve, or twenty-four hours after an exposure, I suspect at once it cannot be a Gonorrhoea. I then enquire if he ever had a Gonorrhoea before, and if he state that he has, my suspicions are confirmed, and I explain my reasons for them. This of course leads to an examination by the bougie, by which the real state is ascertained beyond the posibility of doubt, and he obtains a permanent and per- fect cure. But the value of this true and faithful expla- nation is greater than at first it may appear to be ; for it does not only undeceive and save an individual from pay- ing different persons for pretended cures of Gonorrhoea, but it also saves him from the consequences of occult or hidden Stricture — an evil which I deem by far more seri- ous and distressing than any to be found in the whole range of Venereal maladies. The object of this little section is therefore to show, that, among other causes ca- pable of giving rise to symptoms resembling Gonorrhoea, a hidden, dormant Stricture is one, that this is to be sus- pected whenever these symptoms appear within twelve or four and twenty hours, — but that this is only to be known for fact by passing the bougie. Its treatment con- sists in a little cooling physic, rest, and low diet ; if this is not sufficient, the usual treatment for Gonorrhoea will stop the discharge, but the only proper and permanent cure, is the cure of Stricture. The fourth and last of these disorders resembling Go- norrhoea is A discharge occuring in female children, and which frequently creates distressing apprehensions in the minds of parents. This consists in a discharge of matter from the genital organs, attended with some slight degree of inflammation and uneasiness. But this complaint in children does not originate in the parts themself, but in some distant parts, such as the gums, in teething ; or in the bowels, from foul and irritating accumulations there. This latter is no uncommon cause of the complaint. We know that irri- tation in the bowels in children is readily transmitted to distant parts, and is the cause of various maladies. If this irritation happen to fall upon the head, it produces a dropsy of the brain ; or, if in other parts, then other diseases take place, as sore eyes, or running sores from behind the ears, a swelling of the neck, or others ; so, if it happen to fall upon the mucous membrane of the fe- male organs, it then produces the disease we speak of. It is not, however, that this disease in itself is of so much consequence as the fear and misconceptions it may lead • 8 to. Filled with apprehensions, for instance, a mother takes her little child to some physician, and if he happen to be unacquainted with its real nature, these apprehen- sions are confirmed. I have read, somewhere, of inno- cent persons being hanged from a misconception of the nature of this malady. With regard to the treatment of it, this of course is founded on the view here given of its nature ; remove the cause — that is, scarify the gums il they are inflamed, and cleanse the bowels with an active purge or two. Nothing more is wanted, except plentiful and frequent washing with cold water, perhaps sometimes with the addition of a little alum or sugar of lead. CHAPTER VIII. A few Remarks on that insidious disorder, Leucorrhcea, commonly termed " Female Weakness" or " Whites." (The following, though perhaps not properly belong- ing to this work, is nevertheless closely connected with the subject of the preceding chapter, and may prove use- ful here). This disorder consists, essentially, in a deranged condi- tion of the organs of generation, originating sometimes in a debility of the general system, and sometimes in the sexual organs alone. It may be induced by various causes, such as — any long continued illness — a damp, un- healthy residence — having children to fast — sexual ex- cesses — Gonorrhoea, &c , &c But, in delicate and ner- vous females, it frequently comes on without these inter- vening causes, and becomes as it were the settled habit of the constitution. It does not^ however, thus invade the constitution without disturbing one of its most impor- tant functions, for it leads eventually to Barrenness. There is also a most unfortunate coincidence to struggle with in those who are the subjects of this complaint, for it affects the constitution in such a way as to react upon, and in- crease the original disorder. If, for instance, it originate in weakness of the sexual organs, this, sooner or later, in- volves and debilitates the constitution, and thus keeps up and augments the original weakness ; or, if it begin in general nervous debility, this weakening discharge occur- ring, greatly augments that nervous debility. There is scarcely a complaint which the constitution suffers more under and has less power to overcome without the aid of suitable assistance. This may be clearly seen by reflect- ing on the influence which the uterine system is wont to exert upon the stomach and digestive organs. That train of distressing symptoms which so frequently occurs in a state of pregnancy, is a striking illustration of this fact. Numerous as these are, they all proceed from the effect the uterous (or womb) has upon the stomach, enfeebling and deranging its digestive functions. The very same effects are produced by this complaint, the " Whites," but with this difference, the derangement of the digestive organs from pregnancy is but for a limited duration, while that from weakness of the sexual organs is unlimited and per- petual. Again, by tracing the sad inroad this disorder makes upon the constitution, it will be further seen how justly it merits every care and anxiety to remove it ; for, beside the disappointment of a family, which it is fre- quently the cause of, there is nothing which more cer- tainly fades the youthful countenance, and prematnrely leads to the failings and infirmities of age. The first effect of this never-ceasing influence on the stomach is to weaken its digestive power, by which the blood becomes poor and watery. This is seen by that pale and sunken countenance, or bloated state of body, which always more or less attends it. Then follows an unequal circulation of the blood ; the strength of the body being not sulficient to maintain its equal distribution, some parts have too little and some too much; the feet are generally cold, marking too low a circulation in them, while the head is almost always overcharged, frequently leading the sufferer to suppose that bleeding would do good, than which, by the way, nothing would be more disastrous. Headache, however, arising from this cause, is one only of a long train of nervous symptoms, varying in degree and kind, but continuing to harrass and embitter life to its very latest moments. A more just and clear apprehension of so serious a disorder, therefore, than is generally entertained, can scarcely fail to secure a due and proper attention to the following account of its treatment and cure. In the first place, as this is a disorder which so greatly weakens the digestive organs, and through these the constitution, so the constitution scarcely can be strengthened, while the ori- ginal disease is suffered to remain ; it therefore becomes expedient to prescribe both for the local weakness of the sexual organs, and that of the constitution, at one and the same time, and in the neglect of this rule, is the rea- son why the treatment of this complaint so often fails, Now, this need of applying remedies to the diseased organs, at the same time that we act through the consti- tution generally, makes the use of a syringe absolutely necessary. But upon the kind of syringe used very much depends. The syringe in common use, as I have ob- served before, is not adapted to the purpose, and it is chiefly on this account that we so frequently hear of m- curable and tedious cases, even when the syringe is used. In the first place they do not hold fluid enough to fill the passage, and they have no means for retaining the inject- ed fluid for a due and proper time. These deficiencies lead to the contrivance of my " Female Syringe," which is found to answer most completely. DR. RALPH'S IMPROVED FEMALE SYRINGE.* A, — The Syringe as used for Injections for " Whites. 1 B, — The piece used for this Injection, separately. C, — The piece for giving a Glyster to another person. D, — The piece for giving a Glyster to one's self. Leucorrhcea may occur in opposite states of the consti- tution, and the most important point to be ascertained in any given case, is, whether it is accompanied by strength or fulness of habit, or by weakness and exhaustion. * Manufactured by Mr. Liese, No. 102 John-street. CHAPTER IX. On Stricture of the Urinary Passage, — Its Nature— Symptoms — Consequences — Remedies — and Cure. §1. On the Nature and Causes of Stricture. The essential Nature of Stricture is Chronic Inflam- mation. A Stricture consists, at first, in a loss of that dilating or elastic property by which the urinary passage, which, while at rest, is in a collapsed state, becomes more or less unable to yield or open before the column of urine projected from the bladder : — The diseased condition exists, during the early or first stage of Stricture, only as a soft, swollen or puffy state of the delicate skin lining the passage, and perhaps also of the immediately subjacent tissue. Could a view of it be obtained at this time, a small portion of the passage, from a quarter to one inch in length, would be observed to be merely a little swollen and redder than the rest, and this would generally be situated at about five or six inches inwards, though occasionally near the external orifice, and more rarely still, at both places. The con- tact of an instrument with this spot, discovers it to be EXPLANATION OF PLATE V. Figure 1 Represents the appearance of Stricture in its first or Incipient Stage, consisting in a thickened or swollen state of the skin lining the urinary passage. Figure 2 Is the appearance of Stricture in its second or Dilatable Stage. Here, as is seen, the disease is just beginning to assume a more permanent form, a slight de- posit of diseased substance has commenced under the lining skin, and ridges or bands are formed. Figure 3 Shows the third, or Permanent Stage of Stricture. The deposit under the lining skin is considera- ble, pushing inward upon the passage, (where least re- sistance is offered), the diameter of which is greatly re- duced. PLATE V Figure I Figure 2. Figure 3. very tender or sensitive, the patient describing the .-ensa» tion to be as if a sore or raw surface were touched — which, however, is not the case. In this state a Stric- ture offers but little impediment (sometimes none) to the stream of urine, and no resistance to the passage of an in- strument* So true is this, that, except by a careful, ex- perienced and well-educated hand, it is easily overlooked or missed. This may be called the Incipient Stage of Stricture. (See plate in, figure 1). In the next or second stage of Stricture, an important change has taken place. That portion of the passage which was before in a merely tumefied condition, has now acquired a certain firmness, — it resembles a band encircling the passage, narrowing it at this point, and actually reducing its capacity. It now offers a decided impediment to the urine, and, if a moderate sized instru- ment is introduced, an evident resistance is met ; though with a gentle pressure, it yields, and the instrument pretty easily passes on. This has been aptly called the Dilatable Stage of Stricture. (See plate ur, figure 2). * This very often happens ; persons in truth merely because I hsd detected whom I have examined nnd declared a disease which had escaped their ex to hsve stricture, have afterwards heen ploration. I know this to have happen- to others, (in several instances which ed more than once, though some in- havn come to my knowledee, to Sur- stances I might not have known, but geon«, whose rank ami ability merit foi the kindness of a gentleman who the highest respect, and whose opinion not only stands first in the profession would hardly be called in question), in America, but whose name is placed who have said they had none , at the among the most illustrious of Europe, same time making u^e of remarks to- as 1 have myself heard from the lips of wards myself of a most ungenerous if Velpeau, Sedillot, and others net ungentlemn r.]*- nature . j^d wh 1- - In a still more advanced or third stage, the dilatable condition has appeared — the Stricture has become firm, or callous, as it is commonly called ; the contraction is unyielding, and an instrument meets an abrupt positive resistance, the calibre of the passage being frequently so diminished as hardly to allow the urine to pass at all, or even an instrument of the smallest possible size. This is the Callous or Permanent Stage of Stricture. (See plate in, figure 3). Now, it is not always possible to say that a Stricture is in exactly one or other of these stages, for the disease passes imperceptibly from one to the other — often so slowly that several years, sometimes many years, will elapse before a Stricture has passed from !he first to the second or from the second to the third. I not infre- quently meet with cases just verging upon the third stage, the commencement of which was undoubtedly established twenty, and even thirty years previously; others again will arrive to the same degree in a very few years. A Stricture, in a person of regular temperate habits, will sometimes remain ten or fifteen years without having fairly advanced to the second stage. On the nature of a Stricture also, it should further be observed, there is no natural cure for it. When a Stricture once begins, it is sure to go on increasing, either rapidly or slowly. Fortunately, however, we have the means of curing it by art, as will presently be described. Neither is it curable by medicine — all the medicine in the world, alone, would never cure a Stricture. The causes of Stricture may be numerous. It was said at the commencement of this Chapter, that the essential nature of a Stricture was chronic inflammation. It is now also said that, whatever is capable of pro- ducing or keeping up a long continued irritation or in- flammation in the urinary passage, may become a cause of Stricture, and that occasionally, though very rarely, Stricture seems to be spontaneous In a work of rather a domestic character, like the present, it would be at least useless to enter minutely into the causes of Stricture, yet is it well to state the fact, because, it is of the greatest importance to detect, early, its existence, and, when its symptoms are present, it should be examined into — whether the person has been exposed to its common causes or not. Now, the great and by very far the commonest cause of Stricture of the urinary passage is, badly cured Gonor- rhoea, and Gleet ; and the way in which it does so is this: — Gonorrhoea itself is essentially an inflammation, only of a specific kind. In Chapter I. it was stated that Gonorrhoea began at the orifice of the urinary passage, and that if not promptly and propeily cured, it reached the other end and there became fixed, obstinate, giving rise to great difficulty of cure and permanent Gleet, i. e., it passes from the acute to the chronic stage of inflamma- tion. But, it is well known that the ultimate tendency of inflammation of any kind is to thicken, to indurate the organ or tissue which may happen to be the seat of it — and the specific inflammation of Gonorrhoea has this ten- dency to a degree perhaps greater than any other — hence its proneness to give rise to this disease, Stricture. I think I should be safe in saying that ninty-five out of every hundred are from this cause. The next cause in frequency is Masturbation or Self -pollution* — this would perhaps account for four out of the remaining five; — the other one being from one of the rarer and peculiar causes §2. The Symptoms of Stricture. The symptoms which denote the existence of a Stricture should be considered with respect to those which attend its early, and those which attend its more established stage, and the more, as it is an unquestionable fact, that Stricture may exist in a mild and dormant form, and for a long time, and the sufferer be not in the least aware of it. On this account also it is desirable to be more parti- cular and plain in pointing out the early symptoms of a Stricture, not only because it is in the early stage that its cure is so easily accomplished, but because in this early stage the symptoms are vague and far from directing at- * The local disease produced by this however occupying much about the banefo.1 practice is sometimes actual same spot, have some symptoms in Stricture, but much mors commonly common. (See Chapter xi Maa- it differs considerable from it ; both turbetion^)* tention to the real seat of disease — the urinary passage — and without this knowledge and the proper plan it leads to, all the medicine in the world (and very much is often taken) would never cure it. Now, it was stated that a badly treated Gonorrhoea, or a Gleet, was by far the commonest cause of Stricture. When therefore a person comes to me with a Gonorrhoea that has continued an unusual length of time — several months, for instance — and especially if he has had a for- mer Gonorrhoea, I consider the length of time alone a suf- ficient reason to suspect the possibility of a Stricture, and it becomes my duty to assertain for fact, whether it be so or not ; and here it should be observed that the symptoms presently to be enumerated go no further than to afford a sufficient reason to suspect a Stricture. They do not prove that a Stricture really exists : the positive existence of a Stricture, especially in this early stage, can only be ascertained by examining the passage with the Bougie, which is a very easy and simple thing to do, as will pre- sently be seen. Nothing can better show the difference between the common advertising: knave and nostrum seller and the good and faithful Physician, than the difference of their conduct in the case of Stricture. The former will never trouble you with the sound of such a word, but will sell you colored drops, or pills, or some such thing, as long as you will take them, and then will leave you in a state of mental misery; while the latter will put his questions on the ground of the -possibility of Stricture, and if he should detect the least suspicious circumstance, he will not rest until he has ascertained the fact whether it be so or not. He will then explain the nature of a Stricture, and show the utter inutility of medicine in such a case; and afterwards conduct you to a safe and perfect cure. None but those who see it daily can form the least idea of the chagrin and misery that man escapes who falls into the hands of a good Physician in diseases of this nature. The symptoms about to be described are not compiled from authors, but from the very numerous cases that have come under my own observation, and which are minutely recorded in my Private Case-book. 1 have given them pretty nearly in the order of frequency and importance in which I have found them. Among the very early symptoms of a Stricture, there is one in which great confidence may be placed. It relates to the manner in which the last few drops of urine pass, which is by dribbling away. This is a symp- tom of great value in determining any doubtful case of Stricture, and deserves a word or two of explanation. — Now it happens in the very onset of a Stricture, and be- fore any possitive narrowness has occured, that a certain elastic power with which the passage is endowed, in or- der to expel the urine with a jerk, becomes weakened or is quite destroyed, so that it can no longer contract upon these last few drops, or ^ the consequence is they have to steal or dribble away after the act is over. Whenever I have reason to suspect a Stricture, therefore, I put this question, — Have you observed, when you have finished making water and buttoned up your clothes, whether a drop or two of urine passes afterwards, so as to wet the shirt a little ? and if they say they have, my suspicion is greatly confirmed. This is the most universal, as well as the very first of all the symptoms of a Stricture. Indeed a Stricture cannot exist without it. Not that I mean that this dribbling cannot proceed from any cause but Stricture, for it may proceed from weakness of the parts and other causes ; but a Stricture cannot exist without this drop or two of urine, and therefore whenever this is not observed you may be sure you have no Stricture. Another of the early symptoms of a Stricture is, a scattering of the stream of urine in making water, or a splitting of the stream, or a stream smaller than former- ly ; and if these or any one of these exist, my suspicion is increased. But even though he should have noticed none of these, still I am not certain he has no Stricture, for some of them, especially a diminished stream of urine may creep on so slowly as not to be observed ; and until the stream of urine becomes remarkably diminished a patient is very apt to overlook it, and say it flows as usual. I have had persons tell me this, when, on examining the passage, I found a well marked Stricture, and then, re- flecting on their former way of making water, they have been convinced their stream was not so large as formerly. A certain hesitation in commencing to urinate, although the stream flows fully and easily enough when once started, may be added. It is very common to have this hesitating or waiting longer than natural, then a full stream, then again the dribbling away afterwards. Another circumstance attending the early as well as the later stages of a Stricture, and which in some degree or other is almost always present, is its effect upon the Mind and Spirits, to depress them. — In some individuals this effect proceeds so far as to make them hypochondriac, and in almost every one there is some degree or other of it, so that he is not so energetic in, nor so capable of business as formerly.' By this depression I do not mean that lowness and dejection of the mind produced by gloomy apprehensions, or the deceitful tricks of adver- tising people; these are, indeed, enough to affect the spirits, but the depression I refer to arises from a very different cause, and is often present when there is scarcely any other mark of Stricture. This effect of Stricture on the spirits, arises from the intimate connexion which sub- sists between the sexual organs and the mind. Every body is aware of the effect of a single thought of a certain nature upon these organs. Now it happens throughout the body that whenever one part has the power to affect another, the later also has the power to affect the former. For instance, if a sexual thought, through the medium of the nervous system, has the power of influencing the genital organs, in like manner a diseased condition of the genital organs has the power to influence the mind, and it is on this striking reciprocity of sympathies that Stricture in the urinary passage is so wont to depress the spirits. Connected with this symptom, is also a loss of memory. Patients frequently complain to me that, since their Slricture commenced they have noticed more or less de- fect in the memory, especially of names ; and it is often surprising to see the rapid improvement of this faculty that attends the relief of the Stricture. Sometimes there is a diminution of memory but without the depression of spirits — often both are together. A Diminution of the Sexual Inclination^ or of the Erectile Power. This is a symptom which in very many cases make its appearance early. It is in realty the commencement of Impotence; and though in the early stage of Stricture it is generally noticed in but a slight degree, still it is occasionally at this period a prominent source of complaint A curious case of this kind is at present under my care. Mr. had a Gonorrhoea about four years and a half ago — it was four months be- fore the discharge was stopped, and then a slight Gleet, varying in quantity, but always very little, was left. He discovered the existence of Stricture about two years af- terward, and some months later being with a female he had long known, he suddenly, and in one night, lost his erectile power — become impotent, and has so remained to the present time. So sudden an attack is certainly rare, but it does happen occasionally ; I have seen seve- ral such. It is very common however to have it creep on slowly. These then are the circumstances which denote the early stage of Stricture; and when it is considered that they are circumstances which do not in themselves natu- rally suggest the idea of Stricture, and also that Stricture exists in those who are not at all aware of it, they would seem to be exceedingly worthy of attention. To reca- pitulate therefore it may be stated that, — Stricture is a disease which often exists in those who are not in the least aware of it, but there are certain circumstances which should always lead to its suspicion; these circum- stances are — A slight alteration in the manner of urina- ting, a drop or two of urine which steals away after the act is over, so as to wet the shirt a little — Depression of Spirits or of wonted energy of mind, and failing of memory, or both — Diminution of the Natural Sexual In- clination or of the Erectile power. There are other symptoms which often attend the early or about the first and second stages of Stricture, but which are less constant, that is, they will be found in some cases while in others they will not be complained of at all. Gleet. In many cases of Stricture there is a discharge from the urinary passage, but this does not happen in every case This discharge may be only a little more of that mucous which is natural to the part, or it may be real pus or matter. Whatever it is, however, it varies from many circumstances of excitement, and is generally very easily brought on or increased ; a glass or two of spirits. unusual exercise, sexual intercourse, will produce it, and it more or less easily subsides again. When the discharge is considerable, it is often taken for a Gonorrhoea, espe cially as it may be attended with burning pain in ma king water, and chordee, all of which is very apt to fol- low the excitement of sexual intercourse. This kind oi Gleet may attend all stages of Stricture. (See Chapter VII Weakness and Pain in the Back, is very frequent, and may be present in any stage. It sometimes feels as if the sensation commenced in the groin and running round the hips reached the small of the back Not uncommon- ly this pain is first noticed after lifting some heavy w T eight, and is then taken for " a strain ;" the different plasters, &c, that are applied, seldom give any relief, and many, still unconscious of the existence of Stricture, at last suppose themself to be affected with Gravel or Kidney-disease. I am often applied to for such supposed maladies, the majority proving to be cases of Stricture, and rapidly relieved by an appropriate treatment, to the great astonishment of the patient. Pain running dovm the thighs and legs, and sometimes most complained of in the soles of the feet, should be added here. An Itching or Tickling in the Urinary passage, or when urinating, is another rather common symptom. A frequent desire to Urinate, with more or less inability to hold the urine when the desire comes on, and often obliging the person to rise several times in the night. This, when it exists to any great degree, is a very annoy- ing symptom, and often one of the most obstinate and difficult to overcome ; and unlike most of the others, which spontaneously disappear along with the cure of the Stric- ture, often requires separate treatment. Another effect of Stricture, and one very similar in its nature to the depression of Spirit and of Memory, is that which it produces on the Stomach and Organs of Diges- tion, for the same medium which connects the mind with the genital organs, connects it also with the functions of the stomach. Nothing is more common than to see a train of nervous or dyspeptic symptoms which have re- sisted every means of cure, most happily and unexpect- edly disappear on proceeding in the cure of Stricture. — These two circumstances therefore — depression of spirits and nervous dyspepsia — may very properly be placed among the symptoms which attend the early stage of Stricture. They are not of course to be depended on alone, apart from other symr>toms. for it is well known 10 that they may arise from other causes ; but in cases where there is only a mere suspicion of Stricture, it would be well to consider if either of these where present, for, if so, it would greatly strengthen that suspicion. A Shrinking or Dwindling of the Penis, often with diminished erectile power. It is not easy to account for this, but of the fact itself I am well assured. It is some- times, though more rarely, quite an early symptom. I have had patients apply to me whose only object of com- plaint was this, having observed no other until led to think more particularly on the subject, and not dreaming of a Stricture. On removal of the Stricture, it resumes its wonted size and firmness. But, so far I have spoken of Stricture only in its early stage — at the time when its symptoms are often so few and give so little inconvenience as to allow its exist- ence to be overlooked ; in its advanced stage however, the symptoms are very numerous, and some of them most deeply interesting. The interesting nature of these symptoms arises from their remoteness from the seat of the disease itself, so that when they present themselves, they are never once suspected to arise from Stricture, and, consequently, never get relieved. Many serious diseases, which, from their having proved unyielding under a variety of modes of treatment, have been thought incurable, have been so because they have arisen from Stricture, which was never thought of. Week or sore Eyes. — A few months ago a captain of a merchant vessel from Havana came to me with a re- cent Gonorrhoea ; but who, in a little while, I perceived had got a Stricture also from a former Gonorrhoea. Of course I soon attacked the Stricture, but, as the cure of this proceeded he told me, with the greatest pleasure and surprise, that his eyes were better. Now this was the first time he had spoken of his eyes, though I had noticed they were very red and irritable. He then told me that his eyes had been bad for years, — that he almost always wore a shade, and that they were frequently so bad at sea that he could not open them at all in common day-light. This, therefore, was a case of Ophthalmia from a Stric- ture which had given him so little inconvenience, until a fresh attack of Gonorrhoea occured, that it was never once suspected. By the time the Stricture was cured the eyes got entirely well, and I believe will never trouble him again. But this is nothing new in the treat- ment of Stricture ; nothing is so common as to see com- plaints which had resisted every former mode of cure, particularly diseases of a dyspeptic nature, entirely disap- pear on the cure of Stricture. The symptoms denoting confirmed and long-standing cases, therefore, indeed every thing relating to this subject, is deeply interesting. Sim- ilar cases have frequently occured to me. Sores about the head of the penis and foreskin, much resembling Venereal and frequently mistaken for it, (see Chan, xx ), are also among the symptoms of a Stric- ture. The late Mr. Abernethy, in his work on Syphilis, has admirable shown this fact. To w T hat he has stated I can also add my testimony, for instances have occurred to me in which these sores have proved unyielding under many surgeons and different modes of treatment, but which have got well immediately on treating them ac- cordingly. Sores and other affections of the throat are sometimes symptoms of Stricture ; they occur on the same principle, viz : the sympathy existing between the organs of gene- ration and the throat, — so that disorder in one will pro- duce disorder in the other. Many curious facts might be stated on this subject, but, as I observed, being rather curious than of practical importance, I will state them in a Note. Hypochondria. — There are many remote diseases which arise from Stricture, in consequence of the sympathies which exist between the sexual organs, and distant parts of the body. In other words, a Stricture in the urin- NOTE upon the lips and chin. — Young wo men who have beards are generally The sympathies between the organs less prolific than those who have none- of generation and the throat in both Bingham mentions a case which camp sexes are very striking. Not only is the under his own knowledge of a young beard upon the chin prevented if the lady who had a beard, but lost it aftei testicles are removed before the age of her marriage. All this shows the m- puberty, but also the developement of timate connection which exists be- the throat is hindered, so that the voice tween these distant organs and ac- fails to attain the deep and tenor tone counts for many morbid actions oc- ofmen. It is a curious fact, that when curing in the threat simply from the corresponding organ of the female spmpathizing with a Stricture. Se* U removed, (as the ovaria in spaded Chap, xi in which will be found some animals), the voice becomes deep and interesting and important remarks oc rough in women, and hair shoots out thi« subject. ary passage is capable of disturbing the stomach, and through this medium, of inducing other and remote com- plaints, all of which therefore are correctly placed among the symptoms of Stricture. These complaints are chiefly of a nervous character, as head-ache, low spirits, diminu- tion of wonted clearness of mind, and other hypochon- driacal feelings ; and so evidently are these the effect of Stricture, that they cease as its cure proceeds, while they resist every measure short of this. The hypochondriacal state of mind resulting from Stric- ture of the urinary passage sometimes exists to such a de- gree as to become truly distressing and serious. There is no doubt in my mind that many suicides, happening when the circumstances and other relations of the individual cannot in any way account for the act, are in reality the consequence of the severe mental depression which some- times attends Stricture. In these cases I believe the suf- ferer is generally ignorant of the existence of such a cause of his misery — a knowledge of it would have saved him, for with the knowledge would have come at least a hope of relief, if not of cure : but unfortunately again the false delicacy existing on the subject of diseases of the generative organs tends to operate very unfavorably on some minds. A gentleman whom I cured of Stricture a few years ago, and who was at the time a professor at West Point, as- sured me that he had twice been down to the water at night to drown himself, but happily returned without doing so, from irresolution, — he had a very bad Stricture • 10 Another patient, young, and having a Stricture scarcely advanced to the second stage, carried arsenic in his pocket for some time with the view of destroying himself; — he was in an excellent and prospering husiness. Many have declared to me that their failure in business had been attributable to the effect of Stricture on their mind and energy. I might give a long list of the like. Another symptom I will mention is a hardness and dis- eased condition of the testicle from Stricture. This in- deed may arise from other things than Stricture, but when it thus arises, and this I often find to be the case, it never can be cured but by the removal of the Stricture. As 1 have said before, a contracted stream of urine, more or less, always attends a Stricture, but this creeps on so gradually, and with so little disturbance, that it often quite escapes the notice of the patient. But, as the nar- rowness of the Strictured part increases, that is, as the Stricture grows worse, this alteration or contraction draws attention, for it becomes very small, or divides into two, or sprinkles on the ground, and in very bad cases it passes only drop by drop, and that not without some straining. Sometimes it is necessary to make a great ef- fort at the beginning, and afterwards it will flow in a tolerable stream; at other times the desire comes on so quickly that you cannot retain the urine for a moment. This is when the bladder participates in the disease. The bladder is always more or less disposed to this par- ticipation, so that many patients are obliged to get up in the night to urinate, and this generally increases with the Stricture. Mr. Bingham, of London, a very sensible writer, has exceedingly well enumerated the various sensations and other symptoms which may occur in Stricture. I shall transcribe from his work the most important, leaving out however all technical words. Nothing, correctly detail- ed, can be uninteresting to one afflicted with Stricture. Mr. Bingham observes — " Various kinds of sensations also, are produced in different degrees, by Stricture in the urinary passage; as an itching of the penis or the parts about, and a fluttering or pulsating sensation in. some parts of the passage; numness of the thighs is another symptom; as are also a smarting or burning pain in the head of the penis, and darting pains shooting to and fro from the fundament to this part, or up to the back and loins; pain in the hip, down the thighs and on the inside of the knees, frequently occurs from Stricture in the urinary passage, and pain has also been known in the sole of the foot from the same cause." Again he observes — " Sexual intercourse is apt to ag- gravate the symptoms of Stricture whatever they are. — Sometimes this act is attended with pain and inability to- emit the seminal fluid ; at other times only part of it passes, and the remainder steals away when the erection has ceased. Retention of urine has many times been brought on by sexual connexion in patients troubled with Stricture." " The penis is variously affected by Stricture. Some- times the erections are excessively frequent and trouble- some, and these may or may not be accompanied with seminal emissions, during sleep ; at other times the erec- tions are weak and inefficient, and, occasionally, alto- gether wanting." " Sometimes swelling of one or more of the glands in the groin, and enlargement of the testicle, indicates the existence of Stricture in the urinary passage : and, ano- ther symptom is, hardness to be felt externally in the sit- uation of the Stricture. Inflammation and a gathering in that part between the anus and the testicles, are also symptoms of the disease." " It has been stated upon high authority, that strictured patients cannot comfortably cross their legs ; but when- ever I have had an opportunity to notice this, there has been, besides the Stricture, disease of the prostate gland," (a hardish body situated at the entrance of the bladder, just where the urinary passage begins, and which is ex- ceedingly liable to enlargement in elderly people), " or inflammation about this part." §3. The Consequences of Stricture. The consequences of a Stricture are truly lamentable, not only being distressing to endure, but some of them totally incurable — admitting only of relief. I speak how- ever now of old bad cases, such as have been suffered to run on for years, or badly treated. Besides those sym- pathetic disorders which were noticed in speaking of the symptoms of a Stricture, there are consequences which are more immediately connected with it, and these I next propose to state. One of the first of its consequences is, the effect which straining has upon the bladder. The more resistance the Stricture offers to the flow of urine, of course the more exertion must the bladder make. This leads to a thick- ening of its coats (see plate ), and to other conditions of it which make it irritable and capable of retaining but a very little urine, so that the calls are frequent and press- ing, disturbing sleep and rest. From the same cause also the kidneys are very apt to be diseased. The next effect of so much straining is produced upon the passage itself just behind the strictured part. The force of the urine, as may easily be imagined, dilates the canal and forms a pouch or bag, (see plate 4), in which a portion of the urine lodges. But this, whicn al- ways happen, more or less, may lead to lamentable con- sequences. In the first place it may render the passing of the Bougie impossible; for when the pouch is large, the orifice leading out of it may not correspond exactly with that leading into it, so that the Bougie may easily pass in, but not pass out or through it. And in the next, the urine lodging here, is very apt to irritate and produce disease. Disease arising from this cause is of the most distressing and permanent kind ; matter forms in the sub- jacent structures and makes its way out, both by opening into the passage, and also by opening externally, ulcera- ting through the parts between the thighs. But the worst is, the passage it thus makes will not heal. It is difficult and sometimes quite impossible to prevent the urine passing through it. This is what is called a sinus, ox fistula in perinceo, (plate 4). I scarcely know a more disagreeable and inconvenient thing than a sinus in these parts, — the person is obliged to squat down in making water to do it comfortably. But, to form a true and clear conception of this malady, (and every one should do so, in order to avoid that class of people who produce it), it is necessary to see it in a plate, and with this view I have selected the one on the following page, from one of the best and latest authors on the subject, and from this it will be correctly judged how serious a thing it is to neglect a Stricture. Indeed, so true is this that a very eminent writer on this subject, Sir Everard Home, Sur- geon to the late King of England, in his third volume, has a chapter upon — Diseases of an incurable nature, the consequences of a long continued Stricture, before the proper means of removing it had been adopted. Among the consequences of Stricture also may be no- ticed, a shrinking and dwindling of the penis, with but little erectile power, but to a much greater and more se- rious extent than that mentioned before ; as in the slighter degree, however, the removal of the Stricture restores its natural state. A similar state of wasting of the testicles is also a con- sequence of Stricture. Impotence is another, and the last to notice. This may occur with or without the loss of sexual inclination. There are two ways in which a Stricture may be the cause of impotence-^-the one mechanical, the other func- tional. In the first, the function of the testicles is per- formed, but the fluid is impeded in its passage, or its im- petus so broken as to fail in accomplishing its destined purpose. In the second, the function of the testes seems to be disordered, so as to have lost its essential and vivi- fying principle. This is no difficult thing to imagine, when the nervous structure of these organs, and the ex- quisite sympathies depending on them, are considered. — And, further, this opinion is supported by the fact of so many strictured persons having no children. EXPLANATION ON PLATE VI. A, — A section of a bone. B, — A part of the penis. C, — The scrotum. D, — The testicle. E, — The urinary passage. F, — The bladder, much thickened in consequence of straining to make water. G, — The lower intestine. H, — The Strictured part of the urinary passage, the source of all the disorders of the other parts. I, — The ulceration behind the Stricture, from whence the urine has been discharged into .the sinuses or ulcera- ted passages running between the thighs and scrotum. K, — The urinary passage and neck of the bladder dila- ted, (forming a pouch) behind the Stricture. L, L, L, — The several openings through which the j matter and urine have continually flowed. PLATE VI. 11 These then are the consequences of Stricture, and when to them is added those sympathetic aitections which were arranged among its symptoms, together with the expense, and suffering, and keen reflection which is naturally con- nected with this disorder, it will be seen with what pro- priety it is urged on every one to be careful as to whose care he intrusts the cure of Gonorrhoea. All these consequences are perfectly unnecessary, and would be avoided if the same good sense were exercised in select- ing a proper person in this complaint as w r ould be done in any other. But Stricture is a curable disease, and very especially so in its first stage, and fortunately again, with many, this first stage continues for a length of time. It is fortunate also that its principle of cure is simple, easy and certain. It requires only to be acquainted with this, as given in the fifth section of this Chapter, and at the same time to be furnished with these simple means, in order to enable any one to undertake the cure himself with perfect satis- faction and success. The Remedies for Stricture. First, let it be remenbered, no medicine in the world will ever cure a Stricture. Medicine certainly is given, but it is with the view of removing any other complaint or impediment to the cure. It has been stated and explained that Stricture of the uri- nary passage is capable of materially disturbing the func- tions of the stomach ; a knowledge of this fact is of great importance in the treatment of Strictures, for, as a Stric- ture in the urinary passage has so much influence on the stomach, in like manner the Stomach influences the Stric- ture. Now, we can at all times prescribe for these dis- turbances, and hence the cure of Stricture is so much expedited by attending to the stomach throughout its treatment. My own practice verifies this statement daily. Medicine, therefore, if given, is only for the purpose of restoring or improving the general health, — not for the cure of the Stricture. The Bougie is that without which you cannot cure the disease. Nor is this at all to be regretted, for it is a sim- ple, safe, easy and certain way of curing it. Bougies are made of different materials; two kinds only however, are fit for use : these are the Wax and the Elastic* The Wax Bougies are not so smooth and pleasant to use as the Elastic, but they have the advan- tage, sometimes very useful when there is any par- ticular difficulty, of retaining the shape into which they * Bougies are also made of metals and finding all can be affected by the wax different kinds of compositions — even and the elastic Bougie far better, easi- of Iron, of Catgut, prepared Ivory, er and safer, and always with less in- &c, &c. Some are more fanciful than convenience and pain to the patient, useful, and as to metal Bougies of all All the modern continental authors on kinds, I do not hesitate to condemn Stricture, and there are many, are of them altogether; for private use they this opinion. I have not myself, with are highly improper, and every modern a very extensive practice in this dis- Surgeon who has much experience in ease, used a metal Bougie for severa. this department soon renounces them, years. may be bent; — they are not very fit for private use. The Elastic Bougies are generally to be preferred, they are more polished and easier to the patient, and, if always curved one way, they retain the shape sufficiently well; they are also, when warm, so pliable as easily to accom- modate themselves to the natural curve of the passage. Bougies, both Wax and Elastic, are either Cylindrical or Conic, as here represented. A Cylindrical Bougie. A Conic Bougie. The Cylindrical Bougies are fitter for Stricture in its earlier stages, — the Conic for more advanced cases, \ ,ere absolute contraction or narrowness has commenc- ed; though either may be employed in either case. Of course in the third stage (see plate in, figure 3) Conic Bougies are very preferable. Bougies are made straight, but when they are to be used, are bent into a certain form. This is easily done by warming a little either before the fire or in the hand. The following represents the curve a Bougieshould have. It is of the greatest consequence to give it this shape. The proper curve or shape to be given to a Bougie for using. J The manner of using or introducing a Bougie. (See Plate VII). We will suppose it the first time of using a bougie, — the object being to ascertain for fact whether there really be a Stricture or not. You select an Elastic Bougie of medium size, and holding it in the hand or before the fire, you warm it a little, so as to give it the curve just repre- sented without cracking its polished surface. In giving it the proper curve you will find from its elastic property that it will become straight again. Do not mind this, for, having given it the curve while warm, it will more easily assume it when it meets with the corresponding curve of the passage ; (it is an excellent plan to put it away while warm in such a position as to keep this curved form till used again). You next rub on it a little sweet oil or lard, and then proceed to introduce it. Take the penis, at its sides, behind the head, between the thumb and finger of the left hand, and stretch it for- ward a little, rather pointing upwards, but very little. Then with the Bougie between the thumb and fingers of the right hand, and with the curved end pointing upward, introduce it at the orifice, and pass it steadily on with a gentle and continued pressure till it reaches the bladder, which can be easily told by a peculiar sensation and the ceasing of any feeling of resistance. Take particular care to keep the Bougie in the same position as at first, that is, with its point directed upward, for if the point were to turn to the side, or especially downward, it would not • u EXPLANATION OF PLATE VIL Showing the manner of introducing a Bougie into the Bladder. A, — The Bladder, which, it will be seen, is situated higher up into the body than the urinary passage. B, — The internal orifice of the urinary passage turning upward to reach the bladder. C C C, — The lower C represents the external orifice of the passage, in its common or natural position, and in this state the urinary passage is seen to have a double curve, like the letter x/i reversed. The upper C shows the passage, the penis being held out and upward from the body. The middle C supposes the penis to be held out and a little downward, which position brings the urinary passage as nearly as possible to a straight line — the curve being much reduced. In introducing a Bougie it should be held in this position as soon as the instru- ment is about two-thirds of the way in, i. e., as its point reaches the commencement of the curved portion of the passage. D D, — Shows the Bougie in the first and second of these positions, in introducing it. PLATE VII. pass at all. But suppose you pass it smoothly and easily down a certain distance, and then it suddenly stops ; in this case you are to withdraw the instrument about an inch, then lower the outer end and the penis together so as to tilt the point still more upward, and resume your attempt to pass it on, at the same time stretching out the penis more, as it were pulling it over the Bougie. Pro- ceeding in this way the Bougie will, if there is no obstruc- tion, pretty easily enter the bladder. The manner of Detecting a Stricture in its Early Stage. Now, I have before said that Stricture, in its early stage, offers little or no resistance to the passage of an instrument ; — how then is its existence to be discovered ? It is in the following way: Bring to mind the nature of Stricture in its early stage, you will recollect it consists in a tumefied or swollen spot, very sensitive or even pain- ful to the contract of an instrument, giving the idea of a sore being touched. But, in a healthy state of the urin- ary passage, such a sore spot never exists ; the neck of the bladder, indeed, is very sensitive, but the sensation is altogether different ; you feel, when the instrument touches the neck of the bladder — that is, as it enters the bladder itself — as if you must urinate, — it feels difficult for the moment to hold the urine ; and which is also a great dis- tinguishing mark, it is from seven to nine inches up the passage, — whereas, the tender Stricture-spot is between four and six inches up, very seldom beyond six, and I be- lieve almost never beyond six and a half inches. This .statement may be relied on, — it is founded upon a great number of cases minutely recorded in my Case-Book. Remember the subject is Stricture.* Now, having proceeded with the introduction of the Bougie as described in the preceding page, if the early stage of Stricture exists, when the instrument comes to this point it will give so positive a sensation or sorish feeling as often to lead you to believe it cannot be passed ; this however is imaginary, — hold the instrument steadily there for a moment, the spot will become accustomed a little to the touch, and the Bougie will pass through. Of course this tenderness varies in degree in different indi- viduals and in different conditions of health; it is always however, sufficiently decided to determine the question. A medium size Cylindrical and quite blunt Bougie must be employed, — a very small one would he improper for such an examination. In the Dilatable Stage : — The Stricture may however have passed this early stage, being perhaps in the next or dilatable condition. We will suppose.then, that the Bougie has passed quite easily down a certain distance, and then is suddenly stopped, and you find that even by managing as was before directed, it will not pass on ; you then hold it steadily to the part, gradually, and to a limited and reasonable extent increasing your pressure. This is the * When this soreness is further in, (neck of the bladder) or the diseased it generally indicates either a degree of state of the Seminal organs peculiar to inflammation of the Prostrate Gland masturbation. strictured part, and if it be dilatable, the Bougie will pre- sently pass through, and you will have accomplished the first step towards its cure. There is seldom more than one Stricture whilst the disease is in this stage, and this one, as was before said, is generally situated at between four or six inches from the exiernai orifice of the passage. If there is another, it will generally be only an inch or two in, and would therefore be met with first. Thus when you detect a Stricture very near the orifice, you may reasonably expect to find another further down, but not always. In the Advanced or Callous Stage. — But suppose you come to a Stricture, and, after perhaps a second trial, you find you cannot pass it. In this case then you are to withdraw that Bougie and try a smaller one, exact- ly as before; (remember a medium was recommended to begin with) and if this will not pass then take a smaller still. But it may happen that the smallest will not succeed. Indeed the part may be so irritated by these frequent attempts, that it will not pass on the first trial at all. I have frequently succeeded well at the second when I have failed at the first. In general there is but little or no pain in passing a Bougie, and the de- gree of force is so limited that there would be none felt on that account ; except the Stricture be in what is called an irritable state, which is known by its giving pain im- mediately on touching it, and then it should be postponed until this has been relieved. What I mean is, you must not give much pain by the mere force of pressure. Nei- ther should you go on with an attempt at any time if it is disposed to bleed. A drop or two of blood is of no con- sequence ; the part is so delicate and vascular that a drop may appear on a slight occasion ; but, if there is more than a few drops, this should induce you to lay aside the attempt for the present. In some cases you may not be able to pass the smallest size till after various attempts made at intervals of several days; this however but sel- dom happens ; when it does, you must pay attention to your state of health and habits. Particularly must you pay attention to the state of your stomach and bowels. Take a moderate dose of the Purgative Diuretic Pills from the case, or any other in note 1, avoid a stimula- ting or full diet, and rest as much as possible. A warm bath too is very advisable, but if this cannot be had, bathe the parts well with hot water and a large sponge every night, or night and morning. These directions however will seldom be required, still it is necessary to give them. As to Stricture at or near the orifice or entrance of the passage — this is known at once when a Bougie is found to enter or pass tightly, and yet does not completely fill up the lips or orifice of the passage. Injections. — Although it is not at all generally under- stood, Injections, even where there is no Gleet or Dis- charge, are useful in the treatment of this complaint; their effect upon the Stricture is peculiar and excellent, and is exerted through the medium of the delicate skin lining the urinary passage, and by the condition of which the Stricture itself is greatly influenced. But two kinds, as far as I have discovered, are efficient, viz : the White Vitriol and the Nitrate of Silver in very diluted form. §5. The Cure of Stricture. The cure of Stricture can be accomplished only by the use of the Bougie. Medicine occasionally assists, but the Bougie is that without which you cannot cure the disease. Success, in the treatment of Stricture, depends in an uncommon manner on the proper management of the means employed. The ultimate object in using the Bougie is to pass one into the bladder of such a size (whatever size that may be) as about fills up the capacity of the urinary passage, with- out stretching or giving pain at its external orifice :* that is, supposing the orifice to be healthy — that there is no dis- ease or Stricture just within it. When there is Stricture at the orifice, a Bougie that evidently does not fill the entrance or lips, is still more or less tight and painful.* It is usually necessary to commence the treatment with a Bougie several sizes smaller than the one with which you end it, and to reach a full size gradually. There is naturally a great difference in the size or ca- pacity of the urinary passage, amounting to at least double from the smaller to the larger. The following are the ordinary natural dimensions of the passage, as measured at the orifice •* the middle one may be taken as the average : ooooo Sometimes it is found smaller or larger. The measure of the size of the passage is taken at the orifice or entrance, because here and just before it ends in the bladder the passage is smaller than anywhere else ; and, therefore, what will enter easily ought to pass all the way. An occasional warm bath is very useful. Diet should be ordinary and moderate, strictly avoiding all alcoholic, beverages. * Sometimes the external orifice of the urinary passage is exceedingly- large — in which case there will usually he found another ring or circle a very little way inward, which is the true measure. Note. — Every part and structure of the body is endowed with its own peculiar power of action ; also, every part is endowed with a restoring power, the activity of which is aroused by every deviation from the na- tural and healthy condition of a part. This is no fiction. Indeed, every restoration from disease to health is an illustration as well as a proof of such a principle. Numerous as are the laws which regulate and maintain the healthy actions of the body, these are not more numerous and impor- tant than those which influence and control its morbid actions. A Stric- ture is essentially a morbid action — a deviation from the healthy and na- tural condition of a part ; it has lost is natural elasticity, and if that morbid action which destroyed this elasticity could be removed, the principle I allude to would instantly restore it. Now the Bougie does this. The pressure and excitement of the Bougie upon this delicate structure breaks up and destroys this morbid action and the healthy one immediately succeeds — the natural elasticity of the passage is restored. On the same principle also are the confirmed and callous Strictures cured. Every part of the body is endowed with the principle of absorp- tion. The Bougie, in this case, aided by another powerful remedy, not only destroys the morbid action essential to the Stricture, but powerfully ex- cites the action of thj absorbent vessels, which is the means of removing that callosity. Indeed the cure of Stricture is effected by tha Bougie on the same general principle on which every other disease is cured — it interrupts or destroys a morbid action, when a healthy one succeeds. 12 The Treatment of Stricture at the. orifice is conducted in the same way as when sealed further inward, with this little difference, — it is only neces>ai y to pass the Bougie in an inch or two, or a iiitle beyond the diseased spot. — it will more frequently bear the use of the instrument every day without bringing on an mitation; it is likely to be rather slower in its cure. There is so very com- monly a Stricture at the other end also when there is one at the orifice, that, even where it is not evidently the fact, it would be wise occasionally during its treatment, to pass the Bougie all the way into the bladder. We sometimes hear of Spasmodic Stricture. On this subject much misconception has existed. It may be ad- vantageous however to know that the muscuiar fibres around the mouth of the bladder, designed to retain the urine, and also those fibres a few inches up the passage, designed to throw out the urine with a jerk, are both under the influence of a Stricture, and when this is rendered irritable by any cause, the action of these mus- cular fibres is quickly disordered. It is in this way that spasm in these muscles is so ofl n brought on in persons after drinking,— the excitement of wine and company having made the Stricture irritable. In this state per- haps he goes out of the room to make water, but finds he cannot make a drop. The fact is, the moment a drop of urine touches the irritable strictured part, the muscles, of the mouth of the bladder are thrown into a state of spasm which prevents the urine passing. Neither can you always draw it off, in this case, by the catheter or hollow Bougie. The best plan is to foment with warm Water and take an opiate. If this will not do, bleeding and the warm bath must be superadded. So also, in pass- ing a Bougie, if the Stricture has been rendered irritable by any such cause, ihe moment it presses on it, these mus- cles itre thrown into spasmodic action which hinders its passing through. In this case keep the Bougie gently pressing against the Stricture for some few minutes, — it will frequently succeed by this means, — if not, desist, and give an opiate, &c, as before directed. In some hours afterwards perhaps you may pass it easily. But there is another state of things for which the Bougie is a remedy, beside a Stricture, and that is, a sim- ple stdte of tenderness (without Stricture) extending along half or a quarter of the passage, and toward either end or portion of it. Being led to examine the passage from symptoms warranting the suspicion of a Stricture, it is found that the Bougie passes perfectly well, so far as ob- stiuction is concerned, but, that along a certain distance a great degree of pain is felt. This disorder is different from a Stricture, inasmuch as it consists merely in a diseased or increased degree of insensibility, but it is to be treated exactly as though it were a Stricture. Pass the Bougie, a medium, or above a medium size, every day, or every other day, as the degree of irritation will admit, and keep the bowels and digestive organs in a regulated and healthy state. The effect of this treatment, very generally, is to lessen and ultimately remove this morbid sensibility. If therefore, on every time of passing it, you find the pain and tenderness become less and less, you may depend upon a perfect cure, as well as the cessation of every symptom which originated from it. The Treatment of Stricture in the more advanced Stages is as before said, totally unfit for private hands. When, however, a person laboring under this cannot procure pro- per assistance, it is encouraging to know how he may very much relieve his condition, and to a considerable degree open the passage; generally, at least. The means of doing this are, — great attention to the state of the bowels, especially with reference to their free and easy action, — the use of cooling drinks when irritation is present ro of Soda, the use of the injection for Stricture, sometimes adding to it (if that composed of Zinc is used) one drachm of Laudanum. — and the use of small Bougies, conic, when such can be obtained. It may be very difficult to get even the point of the smallest Bougie to enter the contracted spot ; when this is the case and even a partial entrance has been secured, the Bougie should be allowed to remain in for some time, half an hour or an hour. A great deal of tact and management is often required, but always in *uch cases, keep in view as the most important of all •dvice, never to irritate — to do too much at the time. On the application of Caustic to the cure of Stricture little or nothing has been said in this volume, because, in a work of this nature such treatment only should be given as is safe and practicable for domestic or private use. And again, it requires particular and expensive in- struments, which, even if the patient could obtain, he could not use. I ought also to add here, that great mis- apprehension exists with regard to Cauterization; it is by no means, as now employed, the dangerous and pain- ful operation that every one supposes, but quite the con- trary. Another operation required in some old and indurated cases, is Scarification. The operation is one of great nicety in its performance, but is attended with very little pain, and, in experienced hands, no danger. 12 PART THE SECOND. CHAPTER X On Masturbation, — called also Onanism, Self-Pollu~ tion, fyc. The power or influence exerted by the Generative Or- gans over the body, its different organs, tissues, and even the moral and intellectual faculties, is immense, it is ab- solute, and to those who have never studied the subject, might seem at first almost incredible And this influence is exerted from the first moments of life to its decline ; — in this place, however, we shall consider it only in youth, t. e., from infancy up to the period of puberty, during which time these parts are in a state of inactivity or repose, seeming to slumber, or, to common observation, as serving no other purpose than a mere passage for the urine. In the following pages of this Chapter I am much in- debted to a very celebrated French author,* whose excel- lent mode of illustrating this subject I have adopted. * M. Deslandes. De l'Onanisme, et dans leurs rapports arec la Santt.-—