AGE LIBRARY OF THE UNIVERSITY OF ILLINOIS AT URBANA-CHAMPAICN 616.6 R54o The person charging this material is re- sponsible for its return to the library from which it was, withdrawn on or before the \ Latest Date stamped below. Theft, mutilation, and underlining of books are reasons for disciplinary action and may result in dismissal from the University. UNIVERSITY OF ILLINOIS LIBRARY AT URBANA-CHAMPAIGN AUG 2 !j 1377 L161 — 0-1096 Digitized by the Internet Archive in 2016 https://archive.org/details/ondiseasesofgeneOOrobe DISEASES OF THE GENERATIVE SYSTEM. SfllujgtrateB WITH TWELVE PLATES. JOHN ROBERTQN, Lute of Edinburgh . AUTHOR OF THE PRACTICAL TREATISE ON THE INTERNAL Vsfc OF CANTH ABIDES IN GLEET, SEMINAL EMISSION, LEUCORRHAA, &C. AND ON STRICTURE. LONDON: PRINTED FOR J. J, STOCKDALE, No, 41, PALL-MAJUU 181 ], : / 4 * ;> J. n r :/ ' * 4 • . V ' *• ^ •*’ \. . \ J. lillETTELL, Printer, Marsha. Street, Golden-Square, London. REMOTE STORAGE uu, R&fo TO DR. BAILLIE. Dear Sir 5 When I first proposed to dedicate this hook to you, it did not occur to me that Mr. Home , whose opinions are freely discussed in the course of it , is your relative . But, when you permitted me to ad- dress it to you , you evinced your conviction , that, in such discussions , personed or private motives have not influenced my conduct. It is not, indeed, the person- al or private , hut the published opinions (done, of authors, that I have examined. 1 know also that I am, pn common with others, liable to similar treatment ; and I am sure I shall feel no other emotion, in having my own errors pointed out, than that which excite to the correction of them on the first opportunity. From Mr. Home's doctrines indeed being so close- ly allied to the subject of the present publication, an examination of his opinions was absolutely necessary to my plan . But I do assure you, that, although I have spoken of them with perhaps some severity , I feel the highest respect for the industry and scientific re- searches of that gentleman. His labours in Compa- rative Anatomy will at all times deservedly place him high in public estimation , 11 In dedicating , then , this work to you , I cannot help remarking, that I am perhaps influenced by other sensations, and actuated by different feelings, from those usually felt on similar occasions. In the earlier periods of my life, 1 listened with the most lively in- terest to the tales of my native village, respecting the toils and difficulties, in the midst of which, and con - sequently in unnoticed obscurity, those celebrated men , Dr. William Hunter, Mr. John Hunter, and Dr. Cul- len, struggled to arrive at that celebrity which at last they attained ; and I contemplated with delight their well-earned fame. Such reflections, even now, make me proud of having been brought up in the place which gave birth to such distinguished characters. Permit me to add, that the gratifying reflection of your also being a native of that place, on which, from your justly acquired fame, you have been ena- bled, annually, to confer so many marks of your be- nevolence, gives me greater pleasure than I shall here attempt to describe . Reflecting on you all, as models for the imitation of those who follow you in the same honourable career, I subscribe myself, with the greatest respect and esteem , Dear Sir, Your most obedient , And very humble Servant, JOHN ROB Ell TON 61 , Jermyn Street, St. James's. CONTENTS. PART I. ANATOMY. CHAP. I. Anatomy of the Urinary Organs «... * P. 1 CHAP. II. Anatomy of the Male Organs of Generation 3 CHAP. III. Anatomy of the Female Organs of Generation .... 8 PART II. PHYSIOLOGY. CHAP. I. Physiology of the Urinary Organs 12 . CHAP. II. Physiology of the Male Organs of Generation . . ih CHAP. III. Physiology of the Female Organs of Generation . . 15 Vi CONTENTS. CHAP. IV. Physiology of the Generative Organs common to both Sexes P. 1 7 PART III. PATHOLOGY. CHAP. I. Pathology of the Urinary Organs. Suppression, Retention, and Incontinence of Urine 1§ CHAP. IT. Pathology of the Male Organs of Generation . Seminal Emission . 22 Disease of Prostrate Gland 7 qo Gleet j 33 Spasmodic Stricture 46 Permanent Stricture 50 Fistula in P evince a 57 CHAP. III. Pathology of the Female Organs of Generation . General Observations 60 Leucorr ticca 61 Chlorosis 83 Dysmenorrhcea J — Menorrhag ia 84 CHAP. IV. Pathology common to loth Sexes • Gonorrhcea 87 Lues Venerea 103 PART IV. TREATMENT. Introductory Remarks, 12S CONTENTS. Vll CII.VP. T. Treatment of Diseased Urinary Organs. Of Suppression , Retention , and Incontinence of Urine . 141 CHAP. IT. Treatment of Male Organs . Seminal Emission 147 Di teased Pro > tate Gland 172 Spasmodic Stricture 191 Permam nt Stricture 2*9 Fistula in Perincea 228 CHAP. III. Treatment of Female Organs, Leucorrhcea 230 Chlorosis, Dysmenorrhea a, and Menorrhagia 255 CHAP. IV. Treatment common to Loth Sexes. Gonorrhoea 280 hues Venerea 303 appendix 1 . Critical Examination of Mr Home's Works on Stricture in the Urethra , es c 360 APPENDIX II. Ulcers , Eruptions , &c 389 APPENDIX III. Effects of the Cantharides, with Rules for their Admu nistration 423 The reader is requested to correct the following Errata, which, with perhaps some few other trifling errors, have, in the hurry of professional duty, been overlooked. Tage. line. 1 2 from the bottom, for into the read several. IS 7 from the bottom, for fimbricated read fimbriated. 60 Top of the page, insert Chap. III. Pathology of the Female Organs of Generation. 72 9 from the bottom, for cathartus read cathartics. 100 17 from the bottom, for case read cause. 148 5 for more read less. 153 10 for half a dram read half an ounce. 154 14 for gleet read gleety. 154 8 from the bottom, insert tvuo ounces 178 6 from the bottom, for glans read glands. , 185 8 for willing read unwilling. 195 14 from the bottom, after disease read has occasioned.' 196 5 for depositation read deposition. 222 9 from the bottom, for proves read prove. 233 9 from the bottom, for more read most. 268 10 read with her rapidly encr easing, &c. 274 last line, for half an ounce read half a dram. 289 5 from the bottom, for glans read glands. 292 17 from the bottom, for found read find. 295 24 after of insert mucilage of 303 11 from the bottom, for preventatives read prevetitives. 311 6 from the bottom, for pressure read prepuce. 318 7 for disposition read disposed. 332 1 from the bottom, for either read whether. 352 12 from the bottom, insert the mouth after and* 424 19 dele them. INTRODUCTION. .Notwithstanding the multitude of books, pamphlets, &c. on medical subjects, with which the world has already been favoured, and which are daily issuing from the press, it appears to me, that a rational examination respecting the nature and treatment of many of the diseases of the Generative System has been too much ne- glected. The practice adopted in them has con- sequently been very often unsuccessful ; and, viewing it even in its most favourable light, if the original affection may have been removed, the means employed have too often given origin to other diseases of a more unpleasant nature than the one for the removal of which such treatment was applied. Of this, I have witnessed many instances, particularly in cases of the disease er- roneously termed Permanent Stricture , — a name now ridiculously applied to too many diseases of these parts. Indeed, the opinions inculcated, and rules of practice advanced, in many of these X publications, modern as well as ancient, are fraught with what I conceive to be nearly ap- proaching to absurdity, and demonstrate, at a single glance, the ignorance of their authors re- specting those laws of the animal economy, with which every one ought to be well acquainted, before he attempts to prescribe for any impor- tant disease. In following many of the rules of these wri- ters, and in attempting to imitate their too often confused and improbable statements, disappoint- ment, such as frequently happened with myself, must have been experienced by others in a varie- ty of instances. It was the frequent repetition of such unpleasant occurrences, in my treatment of these important and very general diseases, that first convinced me of the necessity of exer- cising some independence of thought in my reasoning and practice ; and of following those rules alone which would be supported by such reasoning as might of itself be at least as easily understood, as the rules which it inculcated. The chronic diseases, to be examined in this work, (a brief account of a few of which I some- time ago laid before the public), were, previous to that period, either secretly felt, or openly avowed, to be incurable. But it affords me no small degree of gratification, to find, that, where - ever the liberal and candid have patiently follow- ed the mode of cure pointed out by me, they XI have, after a little practice, been as successful as I have been. Since that time, I have carried my investiga- tions somewhat further, and I have found, to my entire satisfaction, that somewhat similar reasoning is equally applicable to several other forms of disease, which, from statements in me- dical books, I, in common with the public in general, had long conceived to be irremediable. But, in prosecuting this subject, I neither have published, nor do I ever intend to publish, opi- nions from the reports of others. I state nothing but what repeated experience has convinced me of ; and if, from the experience of others, it can be proved that I have in any way erred, I shall, with the greatest pleasure, listen to such opinions, and most assuredly confess my error. No one really anxious for the improvement of the subject on which he writes, will ever conceive it any degradation for him openly to retract any state- ment which may at a future period be found defective. It is by the want of such open, liberal, and candid conduct, that medical science has been much retarded ; and it is only by adopt- ing such conduct, that it can ever, in a remarka- ble degree, be benefited and improved. Although, then, in the present work, the evi- dence of facts, and a pretty extensive experi- ence, compel me to dissent from some of my contemporaries ; yet, I shall do them every jus- a 2 Xil tice where the particular nature of my subject will admit of it, while I, at the same time, shall on no account whatever be intimidated from stating my objections where they seem in fault. The erroneous opinions of those men who stand highest in the public opinion, ought indeed to be pointed out with the greatest freedom : For, whatever is either said or done by such men, is not uncommonly, even without much examination, held up to us as a model for our imitation ; while the most important truths, from more obscure characters, are usually heard and believed with the very greatest caution. But whatever I do in this way, I wish it to be par- ticularly understood, both by the gentlemen themselves and their admirers, that it is truth alone I am in pursuit of, not victory : The establishment of any one important fact, which was formerly influenced by error, will give me a pleasure which 1 should fail in attempting to de- scribe. I am sensible that prejudices from first im- pressions are difficult of removal. They are not in general to be at once overturned by clearer and more forcible argument ; but only by a slow and gradual revolution of the mind, which time alone can effect. The mind must first be di- vested of its incorrect habits of thinking, from whatever source these may have been acquir- Xlli ed, before it caa even be open to that which is right. I believe none will dissent from me when I assert, that every public statement, as well as every work, is equally open to fair criticism ; and while it is examined fairly and candidly, though perhaps, as the author may think, rather roughly, he cannot complain. The very act of publishing is an appeal to the public, claiming superiority over other works of a similar nature; and it is therefore for the benefit of the public, that fair and impartial critical examinations are undertaken. An author then, possessing either a liberal mind or just principles, will rather rejoice to see his errors corrected, than allow them to pass into the world, where they may do much harm. I am well aware that indiscriminate appro- bation is certainly both an easier and a more pleasant task than fairly to find fault with, and justly to condemn ; because in bestowing indiscriminate approbation (perhaps one of our greatest bars to the advancement of science), it is not necessary for the writer to have any thing more than a general know- ledge of his subject; and disaprobation, ap- plied in the same indiscriminate wav, unless XIV it adduces stable argument for its principle, inviting the most minute examination, is, though less pleasant, equally easy and perhaps oftener resorted to than even the former. The sort of criticism, however, which is bene- ficial to society, and which indeed deserves the name of criticism, is that which, laying all partiality aside both for and against the author, consists in a candid examination of the principles he has adopted, and of the benefits he has bestowed on mankind in sup- port of them : not, as is too generally done, by holding up his doctrines to the world in mangled extracts, or in statements which either (in that form) convey nothing, or dis- figure his truths. In my private correspondence with various intelligent persons, respecting the nature of my opinions and practice, as well as in my critical examination of the works of others* particularly on diseases of the generative system, it has been perhaps justly observed, that the severity of my style of w r riting, and my disposition to find fault, were considerable, and the keenness of these criticisms perhaps unnecessary. I may here remark, that my enthusiasm for the improvement of my pro- fession may have induced me to employ some XV degree of acrimony in my writings ; but from no other motive have I ever done so. I may also add, that I only wish I had not had such an am- ple field for finding fault, nor such opportunities of employing critical severity. Indeed, nothing even then, where I myself might alone be per- sonally concerned, could have induced me to use it, but the alleviation of human suffering and human misery, — the subject that alone ought to plead my excuse against every lesser fault. In the ordinary duties of life, I hope I am as mild as any one ; but I believe I seldom allow matters of great public importance, upon which I have ventured to write, to suffer from that cause. This disposition, I know, unless viewed as it really is and ought to be examined, is per- haps for myself alone an unfortunate one. Still, I may remark, that I never did, nor ever shall, to my knowledge, wantonly wound either the feelings, or hurt the interest, of any living being. But when I see what I deem science and huma- nity trampled upon, I always shall, at the risk of every private or personal consideration, stand for- ward in defence of such interesting objects. I am well aware of the truth of the remark of an eminent author, that “ he who attempts to shew the failures of a celebrated writer, shall surely irritate his admirers, and incur the impu- tation of envy, captiousness and malignity.” Yet such imputation has no earthly weight with a 4 xvi me ; for, as expressed by the same author, “ if there is any writer whose genius can embellish impropriety, and whose authority can make er- ror venerable, his works are the proper objects of critical examination.” On this principle alone I shall attempt to proceed. To endeavour, at the expence of truth, to please every one ; to al- low gentleness, or politeness to the author him- self to hurt an argument, where personalities can never in justice be recognized, and where per- haps the lives of millions are at stake ; to estimate those works highly because the author has, by some casual accident perhaps, gained a reputa- tion in the world, — are qualities which I neither possess, nor do I envy in him who possesses them. They only tend to retard the improve- ment of an honourable, useful, but imperfect pro- fession ; and the man of talent, or of genuine philanthropy, will spurn at such false delicacy. Still, however, I wish it to be particularly understood, in addition to what I have al- ready stated, that, in my examination of any public statement, I scorn to be influenced by personal or private motives, or by any cir- cumstance but what seems to me the merit or demerit of the subject itself. I believe, in these matters, my conduct will always be the same, (if other circumstances sanc- tion it), to my nearest relation, as to my most inveterate enemy ; to the author at present in XVII existence, as to him who lived a thousand years ago. I sincerely wish the same sort of spirit were more universally diffused ; and, that it were not supposed, as is too commonly the case, that in pointing out an error in any man’s public character, you allude to his every private and most sacred transaction. Every one, then, who is engaged in the labo- rious task of attending the sick, is bound to deliver his sentiments with that manliness and indepen- dence, which ought to characterize those con- nected with a profession which should have for its very basis the purest sentiments of liberality. Nor should he, if his wish is to improve medi- cal science, be intimidated or deterred, because names of acknowledged repute give their sanc- tion to opposite opinions. It ought, on the con- trary, to be remembered, as expressed by a cer- tain philosopher, that “ the influence of names is in exact proportion to the want of know- ledge.” I have no hesitation in saying, that too great a deference to them has, at all times, been highly injurious to many questionsin science, and to none more than those upon which 1 am about to treat. For while the researches of such persons, (even viewing it in the most favourable light,) at most only embrace one point, their word is too frequently esteemed a law in every other ; and thus blunders are committed and sanction- ed, w hich ought never to have been heard of. I XV11I indeed know no character more pitiable, and at the same time more completely useless in the world, than that time-serving creature of the moment, who, without even an attempt at the slightest examination, either respecting the truth or utility of any advanced proposition, relies im- plicitly on public statements ; and, even allow- ing him to be possessed of the power, never ven- tures to contradict or oppose them, however absurd. In fear for himself, and for his in- terest, he obsequiously follows the example of others, and trembles to hazard any opinion which may possibly give the least displeasure to any party. But the man who can, without fear of any one, detect erroneous practices, and pro- pose a remedy, is of service in his profession, and consequently a useful member of society. And even he who can detect an error, without being able to propose a remedy, but who states it in such a clear manner as to induce others to pay attention to it, does no mean service to mankind. It is only the cypher, (if I may use the term,) who does nothing, and the cynic, who carps and quarrels from mere dissatisfaction, who can be easily dispensed with in any department where improvements are wanting. Thus, the man of accurate discrimination, of some experience, and an equal abhorrence of inactivity and of mysterious gravity, ought alone to be selected as a medical attendant to XXI In the common acceptation of the term, are deem- ed respectable, his difficulties will justly seem al- most insurmountable, and his duties complicated, and often mysterious. Thus it is, that the natural simplicity of the profession is, by this too common method of ac- quiring the mode of practising it, rendered wide- ly destructive ; whereas, had other plans been adopted, very different consequences must have been the result. An examination into the nature of, and prac- tical considerations connected with, diseases of the generative system, have ever been involved in unnecessary obscurity ; and, instead of tend- ing to develope these matters, and thereby ren- der them easily understood, it rather seems to have been the wish of those engaged in such dis- cussions, to make them appear complicated, ob- scure, and likely to be successfully treated only when under their own immediate direction, and by some peculiarity of practice with which they alone were acquainted. Yet, defective and objectionable as are the exertions of those alluded to, their attempts to relieve distress are much more commendable, and even undoubtedly more successful, than the impositions and frauds of that herd of professed and murderous quacks, which, to the disgrace of our country, are to be found in every corner of it. These men, without either the knowledge XXII derived from reading, personal examination, or any method by which they can form a proper judgment of the complaints of those who apply to them, prescribe one medicine alone, not only for every stage of disease, but actually for dis- eases of a totally different nature from each other. They also generally employ drugs of an active na- ture, which, unless in instances of accidental success, render their operations more danger- ous, if not more certainly destructive. Their proceedings are similar to those of a bad surgical operator with a sharp knife : he may accidentally perform a cure, but the chances of his failure, if not of his committing mischief, are much more certain. With their advertisements, they indeed impose on the credulous and weak-minded ; and these persons, I am sorry to say, constitute a very great proportion of mankind But men ■who can reason for themselves, are seldom the dupes of such contemptible quackery. In the present treatise, then, I shall, I trust, endeavour to avoid such errors as may lead to unpleasant consequences. I shall dwell much on the practical part, and a great proportion of the work shall be in some measure original. How- ever little useful information it may in the opi- nion of many contain, there shall, I trust, be no- thing introduced which may have a tendency to lead the young and unsuspicious practitioner a- stray. Its substance is a carefully condensed view xxiii of a long and extensive range of practice in that particular line, and now put into the hands of the public, because 1 do think, when I take a comparative view of other works on the same diseases, that a work similar to the present is still a desideratum. In some of these works I know there is much useful matter to be found, and traces of great labour and indefatigable industry ; but, from the confused manner in which it is delivered, it requires considerable advancement in knowledge to make a useful or even a safe selection. I may observe, that I have no particular hy- pothesis to maintain ; no object in view, but purely the removal of those diseases in the easi- est way for the patient, and the most honour- able for the medical attendant. Thus influenced, I shall not enter into long and uninteresting details, which may be found in almost every book. I shall chiefly confine myself to the consideration of such points as may be immediately applied to use ; and even when, reasoning on some of them, and on the works of others, I may leave that track a little, I shall be careful never to do it so far as to lose sight of it. It is worthy of remark, then, that when the generative organs are in a state of perfect strength, and capable of the greatest vigour in generation, the general health is, in almost every instance, XXIV in an excellent state ; and that when the gene- ral health fails, these parts fail in a greater de- gree than many other parts of the body Perhaps there is no disease to which the hu- man fabric is subject, that preys so much on the mind, as the protracted disappointment of one labouring under such complaints. The care- worn and chagrined countenance, and the hag- gard and emaciated body, proclaim, in language that cannot be misunderstood, the dreadful feel- ings of those who bear with them a consciousness of inability to propagate their species. In judging of the particular nature of these diseases, much greater want of discernment is too often exhibited by authors, than we find even in the invention of substances essential for their removal. In the last, indeed, we often find considerable ingenuity displayed ; but what good purpose can this ingenuity serve, when that which alone requires the necessity of it, is entirely misunderstood ? Yet these diseases, as well as diseases in general, though they may have been caused in a variety of ways, can exist under no great variety of states of action. They must depend either on increased, irregular, or diminished action of the system in general, or of the parts affected ; or they may depend on the formation of new substance in the part affected. When it has once been ascertained to which of these states the disease belongs, its removal is XXV in general, comparatively speaking, an easy mat- ter ; but, without considering this, (a mistake by no means unfrequent ), we are apt, not only to be unsuccessful, but we run many chances of committing very dangerous errors, in spite of our most ingenious contrivances. Before a medical practitioner attempts to pre- scribe for any important disease of the generative system, he must, to do ample justice to his pa- tient, have a most perfect knowledge of the structure and uses, in the healthy state, of such parts as are liable to be the seat of such disease. These I shall describe in the most plain and sim- ple manner of which I am capable. Without this knowledge, indeed, he will be perpetually committing blunders, and, however much he may, by technical terms and other subterfuges, for awhile escape detection with the multitude, the discerning and the sagacious will not be long in estimating the extent of his real knowledge, and of valuing him accordingly. As the diseases arising from impure connec- tion, or vitiated habits, most commonly to be met with in the generative organs of men, are lues venerea , gonorrhoea , gleet , strictures, seminal emission , fistulous ulcers , and general debility , or other effects arising from one or more of these causes, occasioning suppression , retention , or in- continence of urine , I shall consider each of them, and give a plain, and I trust, satisfactory view of b XXVI the nature, consequences, and practical treat- ment of each. The most common diseases of the same parts in woman being leucorrhoea, chlorosis dysmenorrhcea memorrhagia & c with gonorrhoea and lues venerea , in common with the male sex, I shall also consider these, and give rules for their entire removal I may remark, that there often exists in both sexes, for years together, even without consti- tuting any distinct disease, a degree of debility of these parts, which renders the patient ex- tremely unhappy. The appetite and excretions are regular, yet still the patient continues mea- gre and distressingly feeble. To these are also added, great irritability and occasional timidity, and dejection of mind. At length, irregularity in the functions of the parts themselves com- mence, and in females, the uterine functions are in some very early disordered, all hopes of pro- geny are at an end, and hysteric, if not convul- sive, affections are extremely troublesome. In the male, the irritability of the whole system is distressingly augmented, he is incapable of pro- pagating the species, and becomes gloomy, sus- picious and morose, and too often flies for re- lief to the use of spirituous liquors, which, al- though productive of momentary relief, slowly, yet surely and irreparably, sap his constitution. 1 have, then, I believe investigated the na- ture and treatment of these complaints much XXV11 more amplv, and T flatter myself more satisfac- torily, than has hitherto been done. 1 have been careful to point out those opinions of authors which lead to errors in practice ; nor, as former- ly stated, need 1 plead any excuse for this, since by no other means can the knowledge of the art be promoted, and the practice improved. In the relation of the cases, I have endeavoured to point out all the circumstances of habit, disease and medical treatment, which might be deemed important. And although I am aware, that a perusal of cases is much neglected ; yet, I have inserted these, because from attention to them, much useful instruction may be derived. I have therefore endeavoured to render those cases that I have detailed as interesting as their nature would admit of. My attention was, several years since, first led to the treatment of some of these diseases by pe- rusing a publication by Dr Greenfield, written about a century ago, and containing some origi- nal observations on that subject. His book has many faults ; but these, though they may tar- nish, do not render useless its better parts. That gentleman who was a man of learning and in- dustry, treated diseases of the generative system in both sexes, and especially those of a chronic nature by the internal use of cantharides. His success, as usual, excited the envy and malice of b 2 xxvm his professional brethren ; and, in consequence of their intrigues, he was actually committed to Newgate! on a charge of prescribing dangerous remedies for the removal of disease! ! Though Dr Greenfield’s account of the powers of this medicine be very extravagant, yet it has, in many points, internal evidence of consistency and truth. All the complaints in which it is there said to be useful, have one character, they are those of extreme debility, and, therefore, might all be rationally expected to be alleviated by one and the same means. In a dissertation also on the venereal disease, written bv Dr Turner about the commencement of the last century, that gentleman, after depre- cating certain means employed for the cure of gonorrhoea and gleet, proceeds to declaim against Greenfield and the cantharides ; but his phillipic, in reality, contains a very high eulogium both on the person and the substance condemned ; for Turner clearly discovers that he never gave the substance a fair trial ; and, even amidst the most abusive invectives, he is obliged to bear testimo- ny to the learning and medical knowledge of Dr Greenfield, as well as to the utility of the me- dicine which he recommended. In the Philosophical Transactions of London, Vol. V. of the abridgment, Mr Younge relates instances of the remarkable utility of the can- tharides internally employed ; but the same XXIX cases are much more fully narrated in Marten’s Translation of Greenfield’s work, where Mr Younge, with the independence of a gentleman, vindicates the reputation of his instructor Green- field. The laborious Astruc gives an account of the internal use of this medicine, and mentions the principal medical men, except Greenfield, who exhibited it. Other authors have mentioned this substance, but I shall only take notice of Dr Forsten, who, in 1/76, published a profound and useful essay on the internal and external uses of caniharides, in which he gives a learned account of the opi- nions of the best authors, both ancient and mo- dern, concerning them. It does not, however, appear, that even by any of these men, the medicine was scientifical- ly used, or managed with that caution which is indispensible to its successful exhibition ; and this it undoubtedly was that excited the general outcry against it. Now, wherever strong controversial disputes prevail respecting the qualities of drugs, some other motive than the developement of truth ge- nerally actuates one or other of the disputants. Under such circumstances, great caution in proceeding upon the opinion of either party, is strictly necessary ; but such caution as will pre- vent our ascertaining the extent of the power of XXX a substance which has been allowed in many ca.-ses to possess properties of unappreciable va- lur can never be approved of, even by the most timid. By incautious conduct we must from time to time commit faults, even with the most common medicine ; and we know that, unless caution is used, even the articles of our common diet may produce much mischief This caution, however, carried to too great a length, which is even more common than the last mentioned fault, completely prevents us from obtaining a knowledge of our most usetul remedies, and consequently of ever effecting a cure of the nu- merous diseases which can alone be remedied by the well regulated administration of them. I add, with pleasure, that 1 have too exalted an opinion of the human mind to doubt that at some future period, we shall be as completely in possession of the means of suppressing the viru- lence of venereal complaints, and of entirely pre- venting the propagation of this dreadful scourge, as we now are of those for the prevention of the small pox. The devastation the small pox for- merly made is fresh in the recollection of all of us, and we have all been fortunate enough to witness its almost complete extermination. The miracle would not be greater were we to to see the same occurrences take place with re- gard to the venereal disease. XXXI To the various gentlemen who have favoured me with their remarks on my opinions and prac- tice, I return my most sincere thanks. Many of these observations, although I doubt not they were made from the best of motives, might have been found unnecessary, had their authors pe- rused the various publications, in the detached papers, which I have at different times submitted to the public. Others, however, I have perused with pleasure, as they at once breathe a spirit of truth and manly independence of thought. I have intentionally avoided entering, at least at present , into a consideration of all the diseas- es connected with the generative system. PART I. ANATOMY. CHAP. I. * Anatomy of the Urinary Organs . ^JL\ie intimate connection between the generative and urinary organs, and the influence which they exert upon each other, both in their healthy and morbid phenomena, renders it necessary that the lat- ter, as well as the former, should here be consider- ed ; while the difference of structure in the urinary organs of the two sexes are, at the same time, so ex- tremely trifling, that they may well be thrown under one general description. I need only remark, that, in the female, the blad- der is somewhat larger than in the male, and the urethra considerably shorter and wider. The kidneys are two oblong glandular or secret- ing organs, of which one is placed on each side, within the upper and posterior part of the loins, up- on the two last ribs. They are almost entirely com- posed of arteries, veins and, secreting ducts. The ureters are two small hollow tubes, of vvhicli one has its origin from the inner side of each kidney within which it commences, from a cavity called its pelvis, and each is, in the adult, about a foot in length. These tubes pass from their origin down- ward, and slightly inward to the urinary bladder, which they enter at its lower and back part, but at a direction so very oblique, that they pass into the lines between the layers, or coats of that organ, in A 2 such a manner, that whatever distends the bladder, must close their apertures. The urinary bladder is situated in that lower part of the trunk of the body, which, in anatomy, is termed the pelvis, and the lateral parts of which form the haunches, immediately behind and somewhat below the bony projection at the inferior part of the belly. The bladder tapers at its fundus or upper part, but becomes broader downward, near its cervix or neck, and again very narrow at the neck itself ; but this neck is so short, that the urethra, or ca- nal leading from it, for the evacuation of urine, seems to take its origin from the broadest part of the bladder. The short neck of the bladder is embra- ced, especially at its inferior part, by a body termed the prostate gland ; all the part behind, and above to which is truly the body of the bladder. The thin layers, or coats forming the bladder, are three ; first, the peritoneal, which is merely a por- tion of the peritoneum, or general lining of the ab- domen, or cavity of the belly, and which covers on- ly the upper and back part of this organ. The under and forepart of the bladder, not invested by this coat, is surrounded by a cellular or membraneous and fat- ty substance, which connects it to the neighbouring parts. The second coat, situated within the former, is a layer of a muscular nature, or capable of con- traction, the fibres of which run in a circular direc- tion, so that, by contracting, they can diminish the cavity and expel its contents. The third coat or layer, the internal lining of the bladder, is of a mem- braneous nature, with a smooth secreting surface, similar to that lining other hollow muscular tubes, such as the intestines, 8tc. 3 CHAP. II. Anatomy of the Male Organs of Generation . The wrinkled body containing the testicles, term- ed in anatomy the scrotum, is composed of a mem- braneous and cellular substance, invested by the common skin or integument of the body, having ex- ternally, along the middle of its inferior part, an ir- regular line called its raphae, from which a sort of septum or partition proceeds inward, in such a man- ner that the bag is divided into two cavities, in each of which a testicle is lodged. The testicles are two glands, or secreting organs, each the size of a pigeon’s egg, situated in the ca- vities just described. Each of these glands is sup- plied with blood from the descending aorta, or great artery, within the abdomen or belly, by means of a long and undulated vessel, which, as it descends to convey blood to the gland, is variously contorted and interwoven with the veins which return it to the vena cava, or great vein within the same cavi- ty. The substance of the testicle is of a white, soft, and apparently pulpy nature, but, in reality, consists of an infinite number of small tubes called seminife- rous, which, at the upper part of the gland, termi- nate in one general duct called epididimis. Before describing this duct, it is necessary to ob- serve, that the glandular bodies which I have just described, are not thus left naked in the cavities of the scrotum. Each is provided with three coats; an internal one called albuginea, whichis smooth, white, tendinous, but exquisitely sensible, and immediately invests the glandular apparatus ; a middle one, ex- ternal to the last, termed the vaginal coat, which, af- ter involving the testicles, runs along with the ves- sels already described as supplying them through the muscles of the belly into that cavity ; and a a 2 4 third, or external one, which is continued from the muscles last mentioned ; is itself muscular, and re- ceives the name of cremaster ; this is fixed around the second or vaginal coat. The convoluted tube, then, called the epididIt mis, of which the origin, from the upper part of the testicle, was already mentioned, descends along the outer and back part of the testicle, without coming into contact with it, till it reaches its lower part, whence it immediately begins to reascend, and form- ing a straighter tube, assumes the name of the vas deferens. The vas deferens, th us proceeding from the low- er part of the testicle, is enveloped in the same membraneous sheath with the artery and vein al- ready described, and forms with them the sperma- tic chord. They run together upward over the os pubis, or bone forming the transverse arch at the lower part of the belly, enter the abdomen by a small aperture placed a little above this, called the ring of the abdominal muscles, and separating from the vein and artery, which continue to pass directly upward, the vas deferens throws, as it were, an arch backward over the lateral part of the bladder, at the posterior inferior portion of which it joins, in its re- spective side, a body called vesicula seminalis, on the inner side of which it passes forward to the com- mencement of the urethra, or outlet of the bladder, into which it opens, after perforating a part of the prostate gland. The vesiculae seminalis are two oblong irregu- lar bodies, situated at the under back part, near the neck of the bladder, or rather between that part and the rectum, or termination of the intestinal ca- nal, which is here placed between and behind it, and a little above and behind to the prostate gland. These bodies adhering to the blacder, diverge at their upper part, and unite in an angle at their low- er, so that it is between them, in some measure, that the rectum is here situated ; and thus a sort of de- 5 pression may be observed on that part of the blad- der. Each vesicula seminalis is composed, not of numerous cells, as they would seem to be, but of one continuous convoluted tube. It does not, as has been supposed, form a continuation of the vas deferens, for that tube only passes laterally along it, and it opens into the urethra at the neck of the bladder, or commencement of the urethra. Be- tween the opening from each vesicula, and at the middle of the prostate gland, is situated an eminence called caput gallinaginis, or verumontanum ; and this body, it has been supposed, has the power of occasionally shutting each orifice of the vesicula. The prostate gland, is a firm glandular body, a- bout the size of a large chesnut, which lies entirely within the pelvis, and wholly surrounds the neck of the bladder. It is formed of two distinct lobes, or rather, it is very much flatted in the centre upon which the rectum lies, and possesses numerous ducts, into which bristles may be easily introduced. By introducing two fingers into the rectum, this gland may be easily felt, and to the touch it seems a hardened or indurated substance. Immediately where the gland ceases t surround the urethra, and where the caput gallinaginis or ve- rumontanum is found, the urethra assumes the name of the membraneous — The membraneous portion op the urethra, which is rather more than an inch in length, lies immediately under the middle of the arch of the pubis, is thin, and easily and often ruptured by introducing a catheter, sound, &c. into the bladder. As a considerable protection to this delicate portion of the urethra, it is supported and firmly attached to the arch of the pubis, under which it turns, by a strong triangular ligament, which, as it rather alters the course of the urethra, renders the difficulty of introducing the catheter, &c. greater. Where the membraneous portion of the urethra terminates, that which is called the bulbous portion a 3 Q of the urethra commences. This bulbous por- tion of the urethra occupies all the perinaeum, and ceases where a muscle called the accelerator termi- nates, or where the skin of the scrotum begins to hang loosely. The urethra is lined by an exquisitely fine, deli- cate, and susceptible membrane, somewhat similar to that of the mouth, nose, intestines, and bladder. This canal has its commencement from the neck of the bladder, and terminates at the orifice of the glans penis. It is in the male about twelve inches in length, though that is very different in different individuals. There are, upon its surface, a great many small ob- long orifices of various sizes, called lacunae. These lacunae enter obliquely into the urethral canal, and are the openings from glands situate immediately under the membrane. Throughout its length, im- mediately under the membrane, it is plentifully sup- plied with these small glands, especially near the neck of the bladder, at which place they are lar- gest. Cowper’s glands are three in number, of which two are situated on the sides of the canal, one on the middle, rather anteriorly to the rest, so as to form a sort of triangle. The membrane of the urethra is of a whitish co- lour, and a striated appearance, in consequence of folds which run along the whole length of the canal. In these folds are found the numerous glandular lacunae, extending slightly under the membrane. These folds are capable of great dilatation, by which the passage may occasionally suffer, with impunity, considerable distension. This membrane is easily wounded by the unskil- ful introduction of the catheter, bougie, he. in con- sequence of which the blood may flow freely from the cavernous portion of the urethra. The body of the penis is principally composed of the corpora cavernosa penis , and the corpus ca - vernosum urethree. 7 The corpora cavernosa penis are spongy or ca- vernous, as their name indicates. They have their origin, on each side, from a bone called the os ischi- um, and from the sides of the arch of the pubis, where they are named crura. They unite under this arch, which is merely the inferior side of the trans- verse bony arch, at the inferior part of the belly, to which they are connected by a ligament. These corpora cavernosa join throughout their length at their inner sides, which thus form a sort of septum, while the two bodies themselves constitute the great- er part of the penis, of which the upper part is cal- led the dorsum. These bodies, however, terminate at the back part of the glans, or extremity of the penis, which is invested by the loose skin termed prepuce. The corpus cavernosum urethras, placed infe- riorly to the last mentioned parts, has little connec- tion with them, except by cellular substance. If commences by forming what is termed the bulb of the urethra, which tube it surrounds in its course, under the corpora cavernosa, to the end of the pe- nis, where it terminates in the glans. The glans penis is covered by a delicate and ex- quisitely sensible membrane, fitted in every respect for the finest impressions. This body resembles in its structure the corpora cavernosa, of which it is the continuation; but its cells are more compressed, and, consequently, smaller than those of the corpus cavernosum. They are beautifully interwoven with a greater number of arteries, veins and nerves, than any other of these cavernous parts. The prepuce is a duplicature of the integuments investing the penis, which may be conceived to pass forward from the external part of that body, and a- gain to return, forming an inner layer under the ex- ternal one ; both of which thus cover the glans. It has nothing peculiar in its structure, except that s small follicles on its inner surface, secrete a sebace- ous matter. The whole body of the penis is covered by a ten - dinous fascia, which, while the penis is in a state of erection, compresses and binds together the parts. On the upper part, or dorsum of the penis, are, two arteries and one vein * the vein is called vena inagna ipsius penis. The arteries proceed from the umbilical ones, and the vein carries its blood to the illiac veins. In their course, they receive small branches from the whole body of the penis. The muscles of the penis are the erectores , the transver sales, and the accelerator es. The erectores penis have their origin from the protuberances of the ischia, run along each side of the penis, and are in their course lost in its caver - nous bodies. The transversales penis have also their origins from the ischium near the origins of the erectores, and are inserted on the outer side of the bulb of the urethra. The acceleratores seem to be a single muscle. It involves the bulb of the urethra with oblique diverg- ing fibres from its centre. It has a tendinous com- mencement from the cavernous body of the urethra, and terminates in a broad tendon on each side of the CHAP. III. Anatomy of the Female Organs of Generation . The ovaria are situated laterally within the ab- domen, and placed between the layers of the broad ligament of the uterus or womb, which is a continu- * 9 ation of the peritonaeum or membrane lining the cavity of the belly. They are almost half the size of the male testicles, and are of a flattened oval fi- gure. Like them, also, they are possessed of two ar- teries and one vein The blood furnished by them comes from the aorta, and returns into the circula- tion by the vena cava inferior. The fallopian tubes are placed somewhat trans- versely within the same cavity, and hang loosely at the outer end, where they have an irregular termi- nation, called morsus diaboli . At the other end each is attached to the uterus, and about the middle of each tube, at its lower edge, is attached one of the ovaria. The canal of these tubes is irregular, be- ing, at its entrance into the uterus, so very small, that it is scarcely capable of admitting a hog’s bristle. Their common length is about three inches; but they vary in different women. The uterus is placed between the internal orifi- ces of the fallopian tubes, on each side, and also be- tween the bladder of urine before, and intestinum rec- tum behind. In its unimpregnated state, or rather before the female has had children, it seems a firm dense substance incapable of containing more than the kernel of a small hazel nut. To its lateral parts are fixed the two round ligaments which are dense firm substances, that extend to the sides of the com- mon cavity, and support it. Its opening at its most depending part is called os tincce. The uterus, in common with the fallopian tubes, is supplied with blood by numerous vessels which enlarge according to the states of the organs. External to the os tincae is the commencement of the vagina, which, like the uterus, is placed be- tween and connected with the bladder of urine and the rectum ; particularly with the latter. This canal is six or eight inches in length, and is of very diffe- rent width in different women. It is capable, espe- cially in time of coition, of considerable contraction 10 and relaxation. It is of a membranous texture, and exquisitely sensible, full of rugae or folds in those who have not copulated very frequently ; while these in general entirely disappear after frequent child- bearing. At its outer orifice, it is guarded by a mu- scle termed sphincter vaginae, which serves in a great measure to keep that orifice close; but the mem- branes being full of wrinkles within, renders it capa- ble of great dilatation even without the slightest in- jury to the parts. Underneath this membrane are placed a great many small glands with execretory ducts called lacunas. The Hymen, or cir cuius membranosus, in the man- ner of a septum, closes the orifice of the vagina in infancy and childhood, and even in those more ad- vanced in years, if they have never been married. The carunculje myrtiformes, are merely the re- mains of the hymen in married persons. The nymphtE are on each side of the aperture of the vagina, and extend upward to a body termed the clitoris. They are largest at this part, which may be considered as their origin, and they almost en- tirely surround the vagina, while, toward the peri- nreum, they almost disappear. Their substance is red and spongy : they are smallest in virgins, while in those who have bom many children, they are of- ten of considerable length, even projecting beyond the labia. The Clitoris is placed at the upper part of the external parts of generation, and under the mons ve- neris. It takes its rise from the os pubis on each side by two bodies termed its crura . These form a ca- vernous body, which, like those of the penis, is di- vided by a membraneous septum. Some muscular fibres are continued from it to the os coxendicis , and are named the musculi erector es clitoridis . The female urethra lies immediately under the clitoris. It is much shorter than that of the male, and is surrounded by a muscle called the sphincter . 11 The orifice is distinguished by a small elevation seemingly covered by the same membrane with that which lines the canal. The mons veneris is the most external of these parts. It is that protuberance immediately over the pubis, and which at puberty begins to be covered with hair* The plumpness of this protuberance alters greatly in different women, and at different periods. In general, where the passions are most lively and strong, it is more full than in those where the pas- sions are of a different description. It is a curious fact also, that this eminence is fullest where the breasts are most prominent ; and in the decline of life, or from other causes, when the breasts become thin and fiat, the mons veneris partakes of the gene- ral decay. The eima magna is that slit or doubling of skin including all the parts now mentioned. The sides of the rima are formed of a continuation of the common skin and membrctna adiposa , and are term- ed the labia, or lips. The inside of the labia is ve- ry delicate, and it is in them where chancres are most likely to be found. The rima commences un- der the prominence termed mons veneris, and con- tinues till near the anus ; the part between its ter- mination and the anus being called perincrum. The general term applied to the whole external parts from the mons veneris to the anus, including the mons veneris, rima magna, labia, clitoris, nym- phse, meatus urinarius, and the vagina, is called the VUDENDUM MULIEBRE. The pudendum contains many lymphatic vessels, which having a near communication with the in- guinal glands, renders the chances of bubo in the female, by no means an uncommon occurrence. 12 PART II. PHYSIOLOGY. CHAP. I. Physiology of the Urinary Organs. Secretion and excretion are the principal func- tions of the urinary organs. The secretion of urine is a process over which the will has no power; but the excretion of it, in a state of health, is always, in some measure, under the influence of the will. It is the kidneys which separate the urine from the blood, by vessels appropriated to that purpose, and this fluid is then conveyed along the ureters into the bladder. From the oblique entrance of these tubes into the bladder, their extremities act as valves, and prevent regurgitation of urine when the bladder is distended with that fluid. CHAP. II, Physiology of the Male Organs of Generation . Previous to puberty, the voice is shrill, as in the female, and there is neither beard nor secretion of 13 semen. When, however, that period arrives, the voice acquires a more masculine tone, the beard and mustachios grow, the pubis is covered with hair, and, the semen being also secreted, the male then begins to be able to propagate his species. Part of the blood which is carried down to the testicles, from the aorta and emulgent arteries, to supply the testicles, is appropriated by them to the secretion of the semen, and after this operation has been completed, the superfluous blood is carried back into the circulation by the spermatic veins. The vas deferens serves to convey the semen from the testicles to the urethra. The vesiculae seminales, which secrete another fluid to be blended with the former, also empty themselves, with a sort of pulse-like contraction, into the urethra, from which it is similarly forced in the same manner at the height and crisis of coition. Although we probably have but an indistinct knowledge of the changes which the seminal fluid undergoes after it is secreted in the testicles, and before it arrives at the urethra ; yet it is extremely probable that the astonishingly numerous convulu- tions of the epididimus, the vas deferens, and even the vesiculae seminalis, have all a certain effect in properly preparing it for use. The prostate gland, as well as the lacunae of the urethra, secrete a fluid by numerous ducts into the urethra, and these are supposed to be the parts principally affected in gonorrhaea. This fluid seems to be a necessary part of the semen. The urethra serves the double purpose of being at once a passage for the urine, and for the semen. The small glands under the membrane of the urethra, constantly yield a quantity of mucus to lu- bricate the parts, and to prevent the membrane from being irritated by the urine passing over it. The prepuce exhibits a curious contrivance of na- ture. W^hen the penis is in a flaccid state, which at 14 time the sensibility of the glans is not called into action, the prepuce then covers it, and in this way, its delicate surface is most effectually preserved ; but, when the penis is erect, when the glans is to re- ceive the most exquisite and sensible impressions, the doubling of the skin, which forms it, in conse- quence of being only large enough, while the penis remained flaccid, is now gradually drawn back in proportion as the penis becomes enlarged, and is then only sufficiently large to cover that part of the penis posterior to the glans, while the glans is left entirely uncovered. At this period the prepuce seems as it were gathered together with a cord, and fastened down at the under side of the glans ; this cord being termed the fraenum. The lubricating glands on the inner surface of the prepuce, are seemingly designed to preserve the moisture and sensibility of the glans, and the lubri- city which is necessary to permit the prepuce to pass backward. The muscles, called erectores penis, are chiefly in^ strumental, not in the erection, but in the direction of the penis. Those termed transversales penis, assist the erec- tores. While this seems one part of their duty, they are also employed during erection, in preserving the cavernous bodies in a state of distension, as well as the urethra and the ducts situated near their origin. The accelatores urinae, as compressing the penis, probably assist as much, if not more, in producing erection, than either of the other muscles. The mind alone does not seem to have an entire power, either over the production of erection, or of our powers of coition. It certainly greatly assists these acts, but, in order fully and satisfactorily to all parties to do these duties properly, there is a certain state of the body which must co-operate with the state of the mind. 15 CHAP. III. Physiology of the Female Organs o f Generation > Previous to puberty, the hymen is entire, the mons veneris uncovered with hair, the breasts are flat, like those of the male, and there is no secre- tion of menstrual fluid. At this period, somewhat different in different countries, these wants are gradually supplied. Na- ture begins to ripen, the hair sprouts, the catame- nia appear, the bosom gradually swells, becomes plump and agreeable to the sight. It is then that females become, in the highest degree, at once or- namental and useful members of society. In action, the ovaria of the female, have been supposed to resemble the testicles of the male. It seems ridiculous, amidst the uniformity, beau- ty and simplicity, of the operations of nature, to suppose that the fallopian tubes are doomed to the double and clumsy office, of first transmitting the semen to the ovaria, and afterwards returning it to the uterus. It is far more probable, that when the semen excites the womb, the ovaria sympathe- tically contract and burst an ovum, the fluid of which escaping, descends through the fallopian tube to the uterus. In the uterus the embryo is deposited, to be nou- rished during the months of gestation. From its vessels, too, the menstrual fluid is separated, when in an unimpregnated state. These are the princi- pal uses of that organ. The vagina is at once the mere external organ of generation in the female, and forms a passage for the foetus at the period of parturition* 16 The execretory glands, placed immediately un- der the membrane of the vagina, are principally for the purpose of separating a mucous matter, parti- cularly during copulation, for the purpose of lubri- cating the parts. The muscle called the sphincter of the vagina, becomes stronger in after life, and renders the hy- men of less use in closing its aperture. The nymphae, in addition to the divided portion of the clitores, seem to aid in closing the vagina, and, in time of coition, also to grasp the penis. They also serve the purpose of folds, which, in time of parturition, are capable of great distension, without laceration. From the delicate structure of the clitoris, and its extreme sensibility, it is the principal seat of plea- sure during coition. When titillated, it becomes erect, and the portion of it which runs round the margin of the vagina swelling, it grasps the penis with rapturous ardour. Menstruation, in the climate of Great Britain, usually appears from about the fourteenth to the six- teenth year. This, however, varies in different per- sons, and it sometimes does not appear till the eighteenth year. This variation can only be consi- dered to be caused by, or as the cause of disease, when the general system is affected by it. Dr Cullen’s theory of menstruation seems equal- ly erroneous with his opinions respecting the na- ture of several of the diseases of the generative or- gans. A11 ow t him his doctrine of spasm, and he will explain any thing ; but deprive him of that me- thod of extricating himself, which he indiscrimi- nately has recourse to when in difficulty, and his hypothesis of these, as well as of many other diseas- es, must fall. It seems to me, that we may, with equal justice, and with as great probability, ascribe every operation in the animal body, to the interfe- rence of spasm, either in a state of health or di- 37 sease. Even were we, however, to adopt that plan, our reasoning in support of such hypothesis could not be less vague, than that which Cullen often has recourse to, in support of his favourite doctrine. In short, his theory of menstruation, seems to me to be equally absurd with that of Aristotle, who supposed it to depend on the influence of the moon ; or that of the chemical physicians, who believed it to be caused by fermentation. Menstruation, therefore, as Dr Cullen seems to suppose, does not depend on any particular force or action of the uterine vessels themselves, but it happens in consequence of a particular change on the whole system at a certain time of life, different in different countries, and in different individuals of the same country ; and the uterine arteries seem naturally constructed so as to assume the power of secreting the menstrual fluid at a certain time, and only under certain circumstances ; although, in the interim, the general health of the individual has un- dergone no apparent change. When, therefore, suppression or retention of the menses occurs, the treatment ought entirely to be indicated by those symptoms, or that general state of the body, which seemed to constitute the principal, perhaps the on* ly cause of these complaints. CHAP. IV. Physiology of the Generative Organs common to both Sexes . Having thus given a description of these parts, and of their individual actions, I shall in the same B 18 simple and brief manner describe them, when mutually assisting each other in the propagation of the species. There can be no question that the healthy action of every individual organ, is absolutely necessary to the right performance of the generative process ; yet we often find, even when these parts are consi- derably deranged, that the offspring, in most in- stances, enjoys health apparently good Still, how- ever, although we cannot trace the particular ef- fects of such derangement in the action of these parts on the offspring, I cannot help being of opi- nion, that owing to these alone we are often to ac- count for the great variety of health, & c. which, at the earliest age, we meet with in one family. As a proof of this assertion, we find that, during the ex- istence of certain states of disease of the generative organs, sterility exists, while, when the parts are restored to their natural healthy action, the power of propagating the species returns. On the connection of the sexes, when the or- gans of both are in a tolerably healthy state, every individual part, probably almost completely in action before, is instantly, in a certain degree, under the influence of the mind, prepared to execute its duty. The penis, in a full state of erection, is grasped by the tensor vaginas muscle, which is sympathe- tically excited, and at that moment is possessed of the strongest contractile power. During this, the action of the seminal vessels being greatly accumu- lated, they, by a spasmodic effort, at length project their contentsby the urethra into the uterus. The in- crease of pleasurable sensation, at this moment ex- cited, causes the fimbricated extremities of the fal- lopian tubes to grasp the ovaria, within which an ovum is immediately burst, and an albuminous drop, thus disengaged, consequently descends along the fallopian tube into the uterus, where meeting with the semen of the male, the future embryo is form- ed. If) PART III PATHOLOGY, CHAP I. PATHOLOGY OF THE URINARY ORGANS. Suppression > Retention , and Incontinence of Urine . T he urine ought always to bear some proportion to the quantity of drink we use. This* however, is sometimes various according to the age or consti- tution of the person, or to the heat or coldness of the weather. Yet these variations never go so far as to constitute disease, but return to their usual state when the temporary cause which induced them is removed. Suppression of urine is that disease in which there is deficient secretion, in consequence of some affection of the kidneys themselves. This may either arise from increased action of the vessels of the kidneys, in consequence of inflamma- tion, from debility, or from original malconforina- tion of these organs. Our opinion respecting these states must be regulated by the state of the pulse, and by other circumstances. Retention of urine, is that disease in which the secreting organs perform their duty, but where the secreted fluid cannot be discharged. R 2 20 Retention may easily be distinguished from sup- pression, by the distension of the bladder above the pubis and in the rectum, with an evident fluctua- tion when the hands are placed at these two points, and some degree of motion given to them. Too long retention of urine at all times occasions inconvenience, and by its consequence in debilitat- ing the bladder, may sometimes be the cause of a most troublesome disease. This disease, when there is difficulty even in voiding a few drops of ■urine, is termed strangury ; when this is attended by considerable pain we call it dysury , and in the state of complete retention, it is called ischury. This disease does not arise from one, but from a great number of causes, often very opposite in their nature. It is often caused by certain states of the mind alone ; by debility in consequence of previ- ous disease of the general system, and of the blad- der as a part of the whole ; by long continued full living, with the constant use of spirituous liquors ; by spasm about the neck of the bladder, or total inaction of that organ itself ; by tumours or ob- structions in the canal of the urethra ; by diseases of the glands of the urethra, such as the prostate ; and not unfrequently it is the attendant of that na- tural decay of the system, which in old age we are all subject to. From these circumstances, it will appear evident, that it is absolutely necessary for us to ascertain what this complaint has arisen from, before we can be supposed to form a true judgment of its nature. Restraining the urine for a considerable length of time, after there has been a desire to evacuate it, deranges the action of the bladder, and causes re- tention of urine. This, in certain habits, without any other cause, has often been known to continue for several weeks, or even months. It is indeed usual for retention of urine, especi- ally in old and debilitated habits, to arise fro ma 21 total inability in the bladder to contract, and there- by expel the contents. This state of inaction of the bladder may arise, even in the most stout and ro- bust, from a long continued habit of retaining the urine, after the bladder has been distended some- what beyond its natural state, and thus relaxing and debilitating the parts. This debility is frequently paralytic. The disease may also, on the contrary arise from a violent inflammatory state of the parts, and this is usually accompanied by a somewhat si- milar state of the wdiole system. The pulse will most certainly indicate the presence of such a state. From retention of urine the bladder is sometimes enormously distended ; sometimes even one or more of its coats are ruptured ; but extraordinary disten- tion is more common than this. In this state of distention, it loses its power of contraction, and thus the disease is constituted permanent. Women are not so subject to dysury and ischury as men are. Incontinence of urine may arise from different causes, and exist in very different degrees of seve- rity. It is most commonly caused, however, by a debilitated state ofthe bladder, or rather of the sphinc- ter muscle of that viscus It may also also exist in consequence of certain diseased states of the urethra, prostate gland, &c. Thickening of the coats of the bladder, which often happens in a re- markable degree, from inflammation, and other causes, is by no means an uncommon cause of in- continence ; but these are not nearly so common af- fections as that first mentioned. The disease is at all times tedious and disagree- ble, but seldom of a dangerous nature. 22 CHAP II. PATHOLOGY OF THE MALE ORGANS OF GENERATION. Seminal Emission , Like every other organ of the body, the seminal vessels have a certain round of action to perform, which, if undisturbed, they will continue to do through a whole course of long life. These actions will also go on with considerable regularity, even where sexual intercourse is altogether neglected ; for the secretion of semen having proceeded to a certain degree, it will naturally be thrown off without Occasioning disease. But, like every other organ of the body, when subjected to continued extraordi- nary exertion, from whatever cause, their action is altered ; they become diseased, and either cease to secrete healthy semen, become incapable of retain- ing it after it is secreted, or are entirely and irre- coverably rendered unfit for again resuming their office. From the commencement of the disgusting ha- bit of self pollution, which is the most frequen t cause of this disease, there is seldom any desire for sexual intercourse ; and although a desire for this should be felt, a repetition of such habits is prefer- red! to natural connection. At length there is in- duced a general lassitude, with a weariness, often ap- proaching to pain, in the loins; the bowels become constipated, often in an alarming degree ; the face becomes pale and cadaverous, and the body in ge- neral dabby or emaciated, with coldness in the ex- tremities. Then occur trembling hands, dim eyes, confused indistinct hearing, if not entire deafness, frequent and violent headach ; drowsiness, without the power to sleep, all attempts at which are inter- 23 mpted by the most frightful dreams; and, in this stage of the complaint, in particular, the patient be- comes terrified to go to bed, lest sudden death should be his fate ; and, during the day, is timid, fretful, terrified, and discontented, he knows not for what, with violent palpitations of the heart ; and though he seems sensible of the cause of his dis- tresses, is unable to abandon his habits, particularly while in bed A complete state of imbecility, both of body and mind, at length ensues, and in some, the haggard countenance but imperfectly proclaims the distraction of the patient’s mind; and I have no doubt that this general depravity, and these its con- sequences, at length terminate the existence of thousands who are supposed to die from very diffe- rent causes. This is a general sketch of these symptoms ; but we must examine them more par- ticularly. I assert with much confidence, that such impro- per practices as induce seminal emission, do uni- formly, sooner or later, according to the original vigour of constitution, subject the patient to a train of sufferings of the most awful nature. One may be affected in a few months, another not perhaps for even a year or two, but none entirely escape ; soon- er or later, they precipitate themselves into an abvss which I should fail in attempting to describe. In some patients, whose generative organs have ar- rived at that state of atony which gives origin to such a complaint, the emission during connection is performed very variously. In some, particularly in the early stages of the complaint, the emission is scarcely to be obtained, at least for a very great length of time ; in others, particularly in the advan- ced stages, the emission occurs inconceivably soon ; indeed, from this cause, some cannot perform the act of copulation before it has taken place. I have frequently observed in seminal weakness, that different persons were in some respects affect- B 4 24 ed very differently. In some, for instance, very gentle friction, such as is caused even by their cloathes while walking, &c. or even an attempt to perform sexual intercourse, was instantly followed by an emission ; while others, although during their dreams they had from one to five or six emis- sions every night, could use any kind of ordinary exercise without causing any effect of this kind ; and whose various attempts, perhaps in the same night, to effect such an evacuation, even in the na- tural way, were quite ineffectual, even although the scene of action was often protracted, and the at- tempt still persevered in, for an incredible length of time. Although these are the most common periods of the disease for such unpleasant circumstances, yet I have often seen this reversed. Other peculiarities also exist in this respect ; for, while some patients propel the semen vigorously, even in advanced sta- ges of the complaint, in others it comes off almost without the patient being aware of it. There is often also felt a degree of irritation or itch- ing, about that part of the urethra where the se- minal vessels open into it, which is generally at- tributed to the presence of strictures, to a disease of the bladder, or to diseased prostate gland ; when it is merely in consequence of diseased action in the seminal vessels themselves, and is removable by whatever restores them to their healthy action. In more advanced stages of the disease, there is often felt a stinging pain, occasionally darting along the spermatic chord, and there is also an almost per- petual seemingly rotatory motion felt in the tes- ticle itself, causing a very great degree of uneasi- ness to the unfortunate patient. The external parts of generation also, in common with the rest of the body, suffer considerably. The penis is shrivelled, and there is often discharged from it a sort of thin- ner fluid than semen, especially while the patient is 25 at stool. Some are incapable of the slightest erec- tion, while others have the most painful erections every night while in bed. The scrotum is in ge- neral lax, and the testicles hang down much lower than natural, and there is a pain experienced ill them of the most distressing nature. That, how- ever, which almost invariably attends those affected with involuntary seminal emission, is involuntary and often painful erection during the night while in bed. These not only prevent the due refresh- ment from sleep, but before morning, reduce the parts to a disagreeable state of painful feeling, which they scarcely recover from before the fol- lowing night, when, from the same cause, they re- lapse into their former state. But certainly the most dreadful of all the effects of this disease, even in instances in which the mind is still alive to the extent of the patient’s own wretchedness, is where a sort of indescribably painful convulsion of the whole body, is experienced immediately after each emission. The patient is even sensible during it, and yet is unable to put a stop to it ; his body is drenched in cold sweat ; and his extremities often for hours after lose, in a great measure, their sense of feeling. It is scarcely also to be credited, but by those who have frequent opportunities of wit- nessing it, what an astonishing effect frequent and involuntary seminal emissions have on every faculty, of the mind as well as on the body. While the bodi- ly form fails, the senses also partake of the general wreck, and are either vitiated or destroyed. The sight, the hearing, the memory, are all less or more impaired. The unfortunate patient is perpetually overpowered by the most painful and melancholy gloom ; he takes no delight in the society even of his greatest friends ; and, in constant anguish and remorse, with perpetual restlessness, often sheds tears at the recollection of his situation. If in com- 26 pany, be is often absent, dejected, and takes no in- terest in the general conversation. He even loves to brood over his misfortunes ; magnifies them, if possible ; is perpetually miserable, both awake and in his dreams ; and the prospect of his being depri- ved of the power of nuptial enjoyment, added to this general state of mind, not unfrequently forces hirn to seek his own destruction. Besides, I have scarcely ever met with any person, whose impropri- ety of conduct had caused involuntary emissions of semen, who had not felt a degree of horror and re- morse of conscience, a shame which pursues him into the most secret recesses, which could not be even equalled by any other condition of mind or body, from whatever other cause. It is by no means an uncommon circumstance for such persons to be so ashamed of themselves, that they cannot assume resolution enough to disclose their situation, even although they may, by so doing, derive much re- lief. They studiously conceal it, they pine, become melancholy, and hate an existence in which they feel no comfort. The settled gloom, too, which envelops many patients affected with this disease, is truly dreadful If there can be a state of mind more fixed and more pitiable than what we under- stand by despair, it is to be found in this state. In no situation does language so completely fail of its power of description, as in this particular in- stance ; suicide is, as already mentioned, not un- frequently its consequence. Such is the alteration which this disease produces, particularly in inveterate cases, that the patients be- come totally different in every respect, both bodily and mental, from what they formerly were. The body is reduced from the utmost state of strength to the greatest possible degree of debility ; in some it is bloated, in others haggard; but in both there is a paleness, which, added to their horror of mind. even as depicted in their countenance, far exceeds the power of description. To this state even the slightest affections of this kind arrive, unless thev are checked in their progress, although often for many years the natural strength of the body may seem un-- impaired. Nothing indeed, as will appear from what I have stated, can exceed the misery of some patients which have come under my observation. They become gloomy, morose, andsuspicious that every person was laying plans for their destruction ; their feelings were indescribable, and they were in perpetual terror they know not for what One gentleman, very much af- fected in this way, assured me that he could com- pare his feelings to nothing so much as if he had murdered some person, and was closely pursued, and in perpetual dread of being apprehended for the deed. Even this is but a faint representation, compared to what is often observed in this complaint ; indeed, it is impossible to express the deplorable state in- to which I have seen many patients reduced. We may, however, mention, in addition to those aheady stated, the feeble and intermittent pulse, easily accelerated by the least exercise, or even change of posture ; — feverishness, and all the symptoms of irregular hectic ; — loathing of food, pains in the stomach, disturbed sleep with fearful dreams, almost continual distress, or rather horror of the mind ; and not unfrequently, complete and incurable atrophy closes the horrid scene ! Now, it is deeply to be regretted, that the common victims of this disease, as arising from self- pollution, are the most active, .intelligent, and, strange to tell, those of the most delicate feelings ; such, indeed, as might have been expected to adorn society ; whose mental capability might have added a lustre to hu- manity, instead of being hateful to themselves, and burdensome to others. 28 Now, were wrong opinions alone to be entertain- ed of the nature of the parts during seminal emis- sion, the fault would not be so great ; but, when we find practical doctrines built upon these notions, and warmly resommended as models of imitation, they cannot be too soon detected and exposed. Mr B. Bell says, in page 227 of his first volume on venereal complaints, that, cc instead of advising abstinence from women, I always inculcate as fre- quent connection as natural desires seem to re- quire ; and, when matrimony is in view, instead of being afraid of it, as often happens with this class of patients, from the fear of their not performing the functions of it properly, I uniformly hold it forth as the most certain remedy.” Now, the disease most probably must have been the same in Mr Bell’s practice, as that which daily comes under my ob- servation ; and I positively aver (unless when the cases were indeed very slight) that sexual inter- course, and even simply toying with women, have alone obstructed a cure of such complaints, and that matrimony, during their existence, can only be pro- ductive of chagrin and disappointment to both par- ties : such individuals being little calculated for ma- trimonial amusements. I may, however, mention, that these indulgences may be gratified in mode- ration, and under proper restrictions, at a certain period of the cure. When the parts have acquired a tolerable degree of healthy action, and have con- tinued in that state, the patient being still under the influence of medicine for several weeks, I have not seen any bad effect arise from very moderate connection in that way ; and it is my uniform prac- tice, where I can conveniently doit, to recommend matrimony to my patients on their .complete reco- very, who, although they at first were unable to have any connection without the very worst effects, can now indulge with the utmost safety and pro- priety. But, before the parts have acquired a toler- 2Q able degree of soundness, this, as I have already said, is always extremely injurious. It is like a per- son who, having lately suffered from fracture of the fore arm, for instance, and being too soon anxious to prove whether or not that part had resumed its usual strength, attempts to lift a greater weight than he is able, which instantly renders the injury even worse than at first Although seminal emission and gleet are some- times to be found existing in one person at the same time, yet they are not necessarily connected with each other, as we oftener find them existing separately. When they do exist together, one of the most obstinate forms of gleet is that w'hich ari- ses from self pollution ; for the individual being conscious of moral turpitude, and at the same time allured by this detestable gratification, perseveres ill his bad practices, and conceals long the malady which gradually exhausts his frame, and at once de- stroys the faculties of mind and his body ; till at length the interference of relations and friends, who are alarmed at the progress of emaciation and de- cay, his own intolerable weakness and dread of death, induce him to apply for medical advice. When w r e are consulted by a person who has gra- dually become feeble and meagre, though his ap- petite w ? as good, or even sometimes voracious, with- out any evident cause ; who tells us that the organs of generation are feeble ; that the slightest titilia- tion excites erection, soon succeeded by seminal emissions and depression of spirits ; that erections are frequent, and emissions very distressing during the night ; that there is, in some patients, a dis- charge of thin, clear, slimy liquid, from the ure- thra ; (though such emissions very frequently ex- ist quite independently of such discharge), that there is great weakness in the loins and joints ; who denies ever having been affected wdth gonorrhoea, or any venereal disease ; complains of no particular af- 30 fection of the organs of generation ; and whose stream of urine is undiminished ; we need scarcely enquire farther ; we know the complaint and its cause ; the latter of which it is our duty to deprecate and prohibit ; while we endeavour, by all possible means, to restore the health, and correct the ha- bits of the almost unpitied sufferer. Not unfrequently, also, this disease is the com- bined effect of self pollution and venereal affection. Mr Hunter, in common with every one else, having no cure for impotence, or indeed any me- thod of relieving it, that disease has, comparatively speaking, seldom come under his observation He says, in page 200, “ This complaint is by many laid to the charge of onanism at an early age ; but how far this is just, it will in many cases be diffi- cult to determine ; for, upon a strict review of this subject, it appears to me to be by far too rare to originate from a practice so general ” But, in- stead of this being a rare disease, I assert that it is a complaint of the most extensive nature, and is undoubtedly caused, in most instances, by onanism at an early period of life. The individuals affected, equally ashamed at the disease and the means by which it was induced, almost always decline apply- ing for medical aid till the symptoms actually threaten a most miserable and lingering death, and often even then attempt to deny the true cause of it. Another consideration which prevented Mr Hunter and others from seeing much ol the com- plaint, was probably the little or no benefit he could afford them. All other means thus fading of suc- cess, and the universal remedy , viz. caustic bougies, in all seemingly inexplicable complaints, being in- troduced to remove them all, it was also applied here, and, as usual, was said to perform cures. 1 may however mention, that I never yet, and I have seen perhaps more cases of this disease than most people, saw one of it which depended solely on permanent 31 stricture, to which alone caustic bougies can with the shadow of justice be applied. I have at all times numerous cases, of the most dreadful nature, under my care, and am able to draw this conclu- sion, that in every country, so far as my knowledge extends, where practices such as I have alluded to are indulged in, this disease is to be found. I, however, have remarked, that such habits, persevered in in warm climates, both encreases the severity of the complaint, and renders it, even after the return of the patient to a colder climate, which ought at all times to take place, much more difficult of cure, than cases which exist only in colder regions. I have distinctly observed, in some cases, par- ticularly when the disease had arrived to a ve- ry distressing pitch, without any check being put to it by remedies, that a total revolution, as it were, of all the actions of these parts, and a regeneration of some of them, was absolutely necessary, before they could possibly be reduced again to their healthy action. No wonder, then, that this disease was deemed incurable, since all the agents employed for that purpose were, compara- tively speaking, totally incapable of nearly produc- ing any such effect. It has been contended bv authors, and among the number by Mr B. Bell, that seminal emissions, constituting disease, for the most part depend on the over distention of the vesiculae seminales with that fluid, which, from the vesiculae seminales being compressed by hardened lceces while at stool, oc- casions an involuntary discharge of that fluid. I should, on the contrary, imagine this to be but ve- ry rarely, if it ever be a cause of such a disease ; as, before the vesiculae seminales can be so much dis- tended with semen as to be thus evacuated by the pressure of hardened foeces (the parts being in a state of tolerable soundness) the operation of the mind, which we know to be so intimately connect- ed with the actions or state of almost every part of 32 the body, must of itself, particularly during dreams, have caused an emission. I have no hesitation in asserting, and my assertions are from careful and repeated observation, that whenever seminal emis- sion occurs while the person is at stool, although the health may in other repects appear good, it must originate from debility of the generative or- gans. Mr B. Bell justly observes, that “ onanism is a habit so baneful to many of our youth, that I be- lieve it to be more destructive in its consequences than a great proportion of all the diseases to which in early life they are liable and this he conceives to be entailed on their posterity. Withers also justly remarks, that old and debilitated fathers, sunk with the infirmities of luxury and debauch, can hardly expect to have children whose constitutions are vigorous. It is a melancholy reflection to a feeling mind, that the weakness and diseases which arise from imprudence, &c. should be entailed on our posterity. From actual observation I am convinced that these different states owe their origin, and even their im- mediate existence, to the same cause, and are, in al- most every instance, removed by nearly a similar treatment. 33 Disease of the Prostate Gland . The most common disease of the prostate gland, is swelling, or scirrhus ; but I believe it does not often ulcerate, unless when foreign bodies, such as the catheter, bougie, & c. excite it to do so. The symptoms of the diseased state of this gland are enlargement of its substance, but without pain, at least till the disease has advanced to a great height. There is, however, irritation, and, without being able to pass more than a few drops of urine at once, there is an almost perpetual desire to void it. Although, then, the first effect of an enlarge- ment of the prostate gland is a retention of urine, yet, after its continuance, it is more commonly at- tended by incontinence. Gleet . There is an affection of the organs of genera- tion, caused by such means as produce atony of the parts, and at times accompanied by a seminal or mucous discharge ; this, in modem times, is dis- tinguished by the name of gleet ; for the ancients termed all seminal, mucous, and purulent emissions from the urethra, gonorrhoeas. I apprehend that a pathological distinction might be made between seminal weakness, or, more pro- perly, a morbid flow of the fluids which contribute to the formation of semen, and that gleet which is merely of mucous. It is certain, that what we now know to be mu- cus discharged from the urethra, was anciently- thought to be real semen ; and some are even yet inclined to believe, that a flow of this last substance very seldom, if ever, amounts to disease. o 34 That there is often a morbidly abundant secretion of the seminal fluid, or even a deterioration of its qualities, I think I shall, in the course of this work, most satisfactorily prove ; and indeed we know, that persons accustomed to indulge in the enjoyments of love, are sometimes visited during sleep, by nymphs of surpassing beauty, for whose sake they are very prodigal of the vital stream. These alluring fancies, which seem to correspond with the vigour of puberty, or even to be the ef- fect of a certain diseased state of the body then in- fluencing the mind, excite all the emotions of the most ardent desire, delude the imagination with hopes of immediate gratification, and often produce to the constitution, even worse consequences than the most excessive indulgence in venery. W e also know that the habit of self-pollution, (previously considered) induces such a distres- sing state of the organs of generation, that titil- lation of the parts, the slightest exertion, or even the operations of the mind, cause a copious invo- luntary seminal discharge ; and the same may be said of the excess of venery, however pure the con- nection. The mucous discharge, however, is constant, and independent of erection ; the seminal discharge succeeds slight erections, during and after which, the sensations resemble those of coition, and cer- tainly does exist when there is as yet no proper gleet, or morbidly abundant mucous discharge, though, in course of time, this gleety discharge is frequently superadded. In gleet also, from whatever cause, along with the continued How of mucous matter, there cer- tainly often are erections, which may be succeeded by the morbid flow of mucous and semen together. Indeed, there seems to be sufficient ground to say, that self-pollution, and excessive venery, induce a morbid flow of semen, in general, before the mu- 35 cous gleety discharge ; but that in gleet, the conse- quenee of gonorrhoea, or of similar inflammatory af- fections, the discharge of depraved mucus has the priority ; the former depending on the debilitated seminal vessels, the latter on the diseased mucous membrane of the urethra. But whether these affections are separate or com- bined, they must be treated by similar means, suit- ed to the existing degree of debility. Here a question naturally suggests itself : Since certain sequelae of gonorrhoeal inflammation have sometimes been denominated gleets ; and there is another affection not produced in the same way, which is also, and in the present age, universally called gleet; would it not tend to perspicuity, to confine the term gleet entirely to the latter affec- tion, and to call the former the second stage of go- norrhoea ? This perhaps might be scientific, and, if careful- ly attended to, would serve all the purposes of practice ; but as both these affections, though dif- ferent in their antecedents, exhibit the same gene- ral and local phenomena, and require similar treat- ment, and (what with me has considerable weight) as conditions of the organs of generation, and of the general system, requiring very opposite ma- nagement, have already been confounded under the name of gonorrhoea, I am induced to think it more safe and more useful, to confine the term go- norrhoea to the active state of inflammation, and to denominate both the other affections above men- tioned, gleets. I see no more reason to give this sequela the name of gonorrhoea, than to call stric- ture gonorrhoea, which is sometimes another se- quela of the same inflammation. it is between gonorrhoea and gleets, then, that we must carefully distinguish. Nor does Mr Hunter always attend to this — in name at least ; for he advi- C 2 36 ses, in gonorrhoea , when the violent symptoms have subsided, the use of turpentine, cantharides, See. (p. 86) If any person, not carefully attending to what was said, had imbibed the idea that Mr Hunter cu- red gonorrhoea by cantharides, what mischief to the patient, and disappointment to the practitioner, might have been the consequence ! This is only to be explained, by considering that when these symp- toms have subsided, gleet commences. If, however, we examine Astruc and others, we shall be convinced that such mischief on these oc- casions has actually happened A gentleman, I may aiso observe, has lately main- tained, that the matter of gonorrhoea differs from pus ; “ for pus has the same formed globular par- ticles, when microscopically examined, as are ob- served in the blood ; which method of examination I prefer to Ch. Darwin’s. Mucus so examined, ap- pears not to differ from gonorrhaeal fluid ; but the discharge from buboes or chancres, has the usual appearance of pus.” * I suspect the author has confounded the matter of gleet with that of gonorrhoea, and we can per- ceive a palpable source of mistake ; for the matter of chancre and of bubu, is at one time glairy, at another puriform, so is the matter of gonorrhoea, in the loose acceptation of the term : it would, therefore, be necessary, in both instances, to men- tion precisely the appearance of the discharges, the period of the disease, and condition of the sores, before we could rely on the accuracy of the obser- vations. But we know that, by the microscope, living men in miniature have been discovered in the se- men, an infinite series of rings in the blood, and, I would add, much confusion in the brain. * Wilkinson on a new method of curing gonorrhoea, p. 1 . 37 With regard to practice, it is not whether the particles discernable by the microscope in the matter discharged, have the same shape with those of pus ; it is not whether the same chemical phenomena result with trials from certain acids ; nor whether the matter is infectious, that afford much important instruction. The information re- quired for this purpose is, a knowledge of that change, either in the general system, in the parts diseased, or in both, which shall render a change of treatment necessary ; this appears to me the nly sound basis of practical discrimination. These two states, then, suggest a very rational ground of distinction ; and, in description, they have been distinguished by the virulent or malignant go- norrhoea, and the simple and benign.* The gleety discharge is more viscid and clammy than that which flows from parts too actively in- flamed for the secretion of pus. Thus, we endea- vour to fix, as precisely as we can, the limits be- tween gonorrhoea and gleet ; but it must be confes- sed, that it would be often difficult to point out where the one terminates and the other begins. Here, however, we perceive two distinct states of disease, one in which the inflammatory diatheses prevails ; another opposite to this, the consequence of inflammation^ As they are opposite, so they re- quire opposite methods of treatment; what will prove beneficial in the one, will be found to be hurt- ful in the other, and vice versa . Some have conceived that gleets, properly so cal- led, are generally the effect of tubercles formed by enlarged glands, callosites, or enlargement of ex- cretory ducts; but, in respect to the opinion with regard to the callosity and enlargement of ducts, how would they account for the cure of the disease * Falck, p. 117. c 3 38 being generally effected by suppurative inflamma- tion ? r hey cannot suppose that callous ducts suffer from sloughing, and that there is a regeneration, either partially or entirely, of these ducts ; for there generally is no appearance of sphacelus, nor does analogy warrant the supposition of such rege- neration. We should rather expect that these ve- ry minute ducts would be either entirely or par- tially obliterated, in consequence of inflammation. Neither have we any right to suppose, that the gleety discharge is the effect of the simple enlarge- ment of these tubes, for it is scarcely to be believ- ed, that an exercretory tube, merely enlarged in di- ameter, should become the conduit of a matter dif- ferent in properties from what it previously con- veyed, since the matter of gleet is widely different from that of healthy mucus. But if we suppose that the small glandular bodies of the urethra being diseased, give out a morbid se- cretion, we shall conceive, at least, a possible, and even plausible, if not on most occasions the real source of the gleety discharge. The enlargement of these bodies will account for the existence of tu- bercles, which certainly have been found in the u- rethra, in as satisfactory a manner as we can ac- count for the existence of buboes in the groin, from the swelling of the inguinal glands. Others have maintained, that gleets were the ef- fect of ulceration ; and these last have some analo- gs iii their favour, for degenerating ulcers produce a matter similar to that of gleet. This opinion was prevalent, at a time when it was not known that any surface, in a certain state ot disease, could produce pus, as well as ulcers ; the presence of ulcers, therefore, was an assumption deemed essentially necessary to explain the pheno- mena. 39 But ulcers, inflamed glands, or any surface in a certain state of inflammation, may form pus ; and all of them, this state of action being changed, may form a matter similar to that of gleet, and of course, give origin to the principal symptoms of that com- plaint. The formation of pus, however, is. not clearly un- derstood by pathologists and philosophers. Dr Thomson, following others, says, in page f)83 of the 4th vol. of his system of chemistry : (e The liquid called pus, is secreted from the surface of an infla- med part, and usually moderates and terminates the inflammation.” But the truth is, that a part, in a certain state of inflammation, forms pus ; and when that state is altered, the pus is not formed. It is not the pus which moderates the inflammation, but the change of condition in the inflamed part, which modifies the secretion. # Nor is it of much importance in the treatment to determine, whether the discharge arises from ul- cers, or from the mucous membrane superficially diseased, since both in ulcers and diseased mem- branes, suppurative inflammation must be induced to promote the cure ; and the remedies to be em- ployed for this purpose, as we shall afterwards be convinced, are in both cases the same. It is not meant, that morbid discharges from the urethra never depend on such tubercles, excres- cences, or ulcerations ; for I have no doubt, as I have already said, that the glands of the urethra become enlarged, swell, suppurate, and produce morbid matter ; and, in short, that ulcers, different with regard to their nature, causes, and. situation, * As this morbid secretion, with regard to the laws of its for- mation, and its sensible chemical properties, is but too little at- tended to in general, I beg leave to recommend to the attention of the reader the account of it which is contained in Vol. IV. p. 6S3, of Dr Thomson’s invaluable work. C 4 40 all very often exist in, or are connected with, the generative organs ; and that thence proceed dis- charges which resemble, or are even accompanied with, the proper gleety discharge. In my own prac- tice, indeed, such things have happened ; for, some time since, I had a case under my care, in which the discharge was of a brownish mixed colour, and there were small round tumours, situate about an inch and a half from the external orifice of the ure- thra, which, during the active means that were used to remove the complaint, suppurated, burst ex- ternally, then disappeared, and the brown discharge ceased. I know also, that gleet depends on a vari- ety of other circumstances ; and that, after violent inflammation is induced, thick layers of coagulable lymph, with substances resembling skin or mem- brane, appear in the discharge, particularly after the application of caustic, and even during the opera- tion of the internal administration of strong stimu- lating medicines ; for then the membrane lining the urethra, &c. is believed to have sloughed off, in consequence of sphacelation. I only wish to main- tain, what facts fully justify, that such causes of gleet exist much less frequently, than at least the older authors would teach us to believe, and that such appearances are oftener the effect of the reme- dies employed, than of the disease itself. The same name gleet, then, is also given to the second stage, or sequela, of the inflammatory state of the gonorrhoea, for the symptoms in both cases become precisely the same, and in both cases the same treatment is required ; indeed, the name would be immaterial, if the two states were distinct- ly attended to, so as to regulate medical practice ; but both ancient and modern surgeons confound them. To confirm the above statement, I need not t quote any one in particular, of the authors of for- 41 mer and present times. We might appeal to all of them, for, in the works of all, the error is manifest. Some of the moderns, however, knowing that the matter of the gonorrhoea is infectious, and not know- ing when it ceases to be so, refuse to be guided by the exact similarity of symptoms and of treatment, and, if the matter discharged is even supposed to be infectious, will not allow the disease to be gleet, whatever the atony of the parts of generation, and general debility may be ; they might, however, in my opinion, as well maintain, that an inflamma- tion of these parts, accompanied wdth a flow of pus, is not a gonorrhoea, because it has not arisen from the venereal virus, or because it is not infectious. Falck, author of an excellent treatise on the ve- nereal disease, who very explicitly anticipates many opinions which Mr John Hunter deemed peculiar to himself, details very accurately the symptoms of gonorrhoea and gleet, and yet he says, (page 122.) * e we find too often many with a continued run- ning, and though it is called a gleet, yet it is, in fact, an old virulent clap.” In the same manner, Mr John Hunter says : “ The distinction between a gonorrhoea and gleet is not yet ascertained ; for the inflammation subsid- ing, the pain going off, and the matter altering, are no proofs that the poison is destroyed.” In short, he maintains, (page 100.) cc that a gleet differs from gonorrhoea ; first, by the absence of infection ; and, secondly, by a dissimularity in the discharge, which,” he says, “ consists of globular bodies, floating or wrapped in a slimy mucus, instead of serum.” Now, the infectious nature of the matter dis- charged, is not a proper ground of distinction in practice, for we do not know from the appearances, whether the matter is infectious or not ; while, from whatever cause the inflammation of these parts is produced, our treatment must be the same ; nor is it of importance in this respect, whether the dis- 42 charge, accompanied by the general symptoms of gleet, be infectious or not, since the general means are the same by which the atony of the parts, and debility of the system, however induced , are to be removed. If, as sometimes happens, in defiance of any means, the discharge of gonorrhoea becomes thin and watery, though it still retains somewhat of the colour and opacity of pus, and be accompanied with pain in the urethra, we are to consider gleet as com- menced, and must have recourse to more active treatment Mr John Hunter, indeed, has something like this in his view, when he treats of gleet, (page 99.) “ Whatever method has been used in the cure of the venereal inflammation, whether injections or in- ternal medicines, it often happens that the forma- tion of pus shall continue, and prove more difficult of cure, than the original disease.” Perhaps there is scarcely any cause which ope- rates so strongly in the production of this disease, as strong injections for the cure gonorrhoea. Acrid injections also, for the removal of gleet, a practice by no means uncommon, tend very much to pro- long and increase that complaint. But, above all, the most frequent cause of gleet succeeding gonor- rhoea, is the too common practice of squeezing the penis about the termination of that disease, to as- certain if there still remains any discharge. Gleets, then, seem most commonly to arise from gonorrhoea, in consequence of impure connection, or for the means used for their removal ; not so commonly, and seldom of any long continuance, from such gonorrhoea as originate from any other causes, however great the inflammation may be which produced them, nor even from the most vio- ent inflammation that can be produced by the in- ternal use of any kind of medicine. 43 In gonorrhoea, then, the discharge often becomes more thin and less copious, and at times ceases al- together ; but is renewed plentifully by no great de- gree of exercise, or intemperance in eating and drinking, and retains its yellowish or puriform ap- pearance ; it even happens, that the discharge is sometimes irregular, without any obvious cause. After the complaint has proceeded for a space of time, of various duration in different individuals, at length the pain goes off, the discharge gradually degenerates into the glairy and mucous form, with evident atony of the urinary organs. This is confirmed gleet ; and now the most ac- tive remedies must be employed. Gleet is uniformly, for sometime after its com- mencement, a local disease, but in time it proceeds to affect the general system. Previous, or subse- quent to this, seminal emissions not unfrequently accompany it, the body becomes pale, emaciated, and feeble, and the mind not unfrequently partakes of the general affection. There is a settled pain, often more severe at one time than another, sometimes attending such affec- tions of the urethra as gleet, which induce some practitioners to imagine, that it arises from an in- flammatory state of the system, when it is simply a consequence of morbid action of the parts, and is uniformly removed with the disease, by stimulating applications. Sometimes, after impure connection, the first symptom of disease is a copious flow from the ure- thra, while the other usual inflammatory symptoms can scarcely be said to be present ; such a case, in difficulty of cure, and absence of inflammatory- symptoms, resembles gleet more than gonorrhoea ; it is aggravated, too, by the antiphlogistic plan, and only removable by the stimulant, wherefore I would class it among gleets. 44 Thus, we have considered gleet as a distinct af- fection, but it is of importance to consider it rela- tively to those affections with which it is found combined, or on which it may depend There is a certain inherent connection, and mu- tual dependence, which are maintained in all the organs and parts of the living body, so that when one part is disordered, another also evinces signs of disorder. The laws of this connection and depen- dence, are still among the secrets of nature. But we find names for what we do not understand, and this fact is expressed by the term sympathy. According to this inexplicable sympathy, then, the organs of urine and generation participate rea- dily in the affections of each other ; and they extend their influence to other organs, particularly the sto- mach, which seems very much disposed to sympa- thise with them. The morbid secretion of the mucous membrane also, seems, on many occasions, from the constant gnawing pain stretching along all these parts, to ex- tend even from the pelvis of the kidneys, to the ter- mination of the urethra. There is a sense of weakness, and often pain, in the region of the kidneys, extending along the course of the ureters, and gritty particles are dis- charged along with the urine, which often contains a great quantity of gelatinous substance. Gleet is combined with almost every morbid af- fection of these parts; with that state in which cal- culi are formed ; with spasmodic affections of the kidneys, bladder, and urethra; with thickening of the coats of these organs, and their canals ; with en- largement and induration of the prostate gland ; with induration swelling, and even wasting of the testicles ; not unfrequently with hydrocele, and the various berniae ; with strictures and obstructions of every kind of the urethra, or the other urinary pas- 45 sages ; with paralysis affecting partially, and some- times totally, one or other of these organs. These circumstances must very much modify our procedure in the treatment, and regulate our judg- ment, with regard to our hopes of success. Nor are those means, which may be found very effica- cious in removing or curing uncombined gleet, to be condemned, or deemed inert, because they fail in removing it, when it is only a subordinate symp- tom of some really more formidable complaint We might as well condemn cathartics, because, in some affections of the brain, the bowels are immoveable by them. Neither are we to condemn a remedy, because a complaint may return. We may as well condemn mercury, because we are again liable to the venereal infection ; or the whole practice of physic, because all mankind die. All rational men of our profession know, that there is no specific remedy, no substance that can, in every instance, remove a given disease ; we only look for such substances as are most useful in a ma- joritv of instances; and such are our best remedies. No men, indeed, are more sceptical with regard to the efficacy of substances, applied to the body, either internally or externally, in the removal of morbid affections, than medical men ; they meet with so many disappointments, and their hopes prove so often fallacious, that some esteem the sa- lutary change that succeeds the admission of a sub- stance into the system, rather as a fortunate acci- dent, than as a favourable event, operated by the powers of the substance. To doubt, says an ancient philosopher, is to be wise ; but, on some occasions, to doubt, is to be in- capable of judging If a given change takes place in the system repeatedly, and then only when a cer- tain substance is administered, we have no more reason to doubt that this change is the result of an action induced by the substance administered, than 46 when an alkali and an acid are put into a vessel, and a salt produced, we have reason to doubt that this salt is the result of their combination. STRICTURE. Of Spasmodic Stricture . Spasmodic Stricture is an affection of a very dif- ferent nature from that which is of a permanent kind ; its approach is in general sudden, and often very violent ; it may appear in various parts of the urethra at the same, or at different periods ; but sel- dom, if ever, till a considerable time has elapsed, or till irritating substances have been applied to it, do they become of a permanent nature. These stric- tures also, if properly treated, never require the ap- plication of caustic substances for their removal, but may, in every instance, however severe, be ob- viated by other milder means. The existence of spasmodic stricture, is not a- lone indicated by its suddenly, and almost entirely, obstructing the urethra, and by its departure taking place in the same sudden way ; spasmodic contrac- tion may be various in its severity, as well as in its extent and duration ; and, if this were well under- stood, it would, in most cases, account for the irre- gularity of time which is often observed in its ap- proaches, as well as in its disappearance. The great- er proportion of the cases, I may observe, related by Mr Whately, in his pamphlet on strictures, were 47 purely spasmodic. In some of them, however, per- manent strictures, and in others an irregularity in the canal of the urethra, were formed solely by the ill- timed application of the bougie. Mr Wadd’s cases were also evidently all of a spasmodic nature; indeed, he wishes to prove this ; but in many of them, even the spasm did not exist previous to the introduction of his bougies. And that Home’s were generally so also, I shall endeavour to prove. An unprejudiced perusal of these cases, however, will at once convince any one of the truth of what I now state. Previous to my investigations respecting the cure of gleets, and some other affections of these parts, they were deemed irremediable, unless they yielded to the most common, though at that period the only means of cure that were known. When, under these circumstances, as almost always happened, the gleet could not be removed, it was at once concluded, that it existed in consequence of stricture ; a bougie was instantly introduced to as- certain this; the spasmodic contractions which en- sued, were alone caused by this application, and these contractions, frequently repeated, sometimes ultimately became permanent strictures : this again occasioned a train of cruel practice. Spasm, then, is apt to occur in every part of the urethra, from its external orifice to the bladder; nor does it seem so much influenced by the action of the muscles surrounding a part of the canal, as we at first sight would ima ine. It has been sup- posed to exist most frequently in parts nearest the bladder, tut my experience does not warrant me to draw such a conclusion ; for I have found it equally severe in every part of that canal. What must have greatly contributed to the opinion, that spasm was most frequent nearest the bladder, is the length and curvature of the urethra, which, even in its heal- thy state, may present various obstructions to the 48 passage of the bougie ; or they may have been caus- ed there by the irritating property of the instru- ment. It is remarkable that Mr Home, in mentioning the usual situation of strictures in the urethra (page 28.) assures us, that, in his practice, there was al- ways one stricture about seven inches from the ex- ternal orifice, whether there were others or not. In other words, I should say, the most common si- tuation for permanent stricture, is certainly to be found at that part of the canal where, from its na- tural curvature, there is the greatest difficulty in passing the bougie. It is curious also, that in parts similarly con- structed, in some respects, to the urethra, strictures have not been more frequently discovered ; and it is not improbable that this may be solely owing to the parts, such as the whole intestinal canal, & c. not being so liable to surgical treatment. It would bring no merit to the present numerous operators of permanent stricture , even to hint at the possibili- ty of that disease existing in parts, such as those mentioned above, where surgeons could not apply their means of cure. A bold step, however, has been made toward this, in the attempts which have been made to persuade people that they might be affected with stricture at the extremities of this ca- nal, (to them the caustic might be applied) viz. in the rectum and oesophagus ; when it is probable some hoemorrhoidal tumors were the cause of the one, and globus hystericus the cause of the other. Mr B. Bell, whose experience was certainly great, in speaking of the effects of gonorrhoea, ob- serves, that “ the irritation produced in the urethra by it, is in some cases so very great, as to excite contraction of the passage in a very distressful de- gree. I have known,” adds he, “ the urine so completely obstructed by this alone, as to give cause to suspect that strictures were formed of the most 49 alarming nature ; in which, neither staff, cathether, nor bougie, could be introduced, but with more force than can ever with safety be applied.’' Mr Home, in his opinion respecting the existence of permanent stricture, and his practice for its remo- val, never even notices this. I may remark, that it is alone by the discernment of the medical atten- dant, that these different states of disease are to be known, and consequently their entire removal sci- entifically effected. When the parts, by their diseased action, or by some peculiarity of constitution of the individual, assume a violently spasmodic action, and when the want of patience or want of discernment of the surgeon, lead him to mistake in practice all such obstructions for permanent stricture, and to act ac- cordingly, the unfortunate patient is often reduced to a state of great wretchedness and misery. We frequently find, that obstructions in the ure- thra do not appear for a considerable length of time, even after the membrane of the canal has assumed that state, which ultimately induces such a disease. But at this time a disagreeable sensation is felt in one or more parts of the urethra, and this often conti- nues for months, when at last the irregularity or contraction occurs. When stricture has once commenced, the causes of its increase are numerous; irregularity in living of any kind, exposure to cold, fatigue, or exertion, particularly riding on horse -back, all conspire to render the state of the patient at times almost in- supportable. The occasional, and in some, the al- most continual straining to void urine, renders their situation peculiarly distressing, and a continuance of this, augmented in proportion to the length of its continuance, at length actually throws them in- to fever, and the effect of this, combined with the state into which the bladder is thrown, by violent and long continued action, or perhaps from disten- D 50 sion arising from inability to void urine, brings their very existence into peril ; even death, from slough- ing or mortification of the parts, occasionally hap- pens. Certainly, when we reflect on the many causes to which strictures of various kind and degree owe their origin, and by which they have their existence prolonged, we must at once perceive the absolute necessity there is for considering, and relieving them in some scientific way ; not by the farrier- like, I would say, inhuman methods, too common- ly practised at the present moment. Under these dreadful plans of practice, it is inconsistent with every reasoning faculty of the human mind, to sup- pose that they should be so often successful as they are represented to be, and that none of those in- stances of human misery, certainly oocasioned by it, but always attributed to other causes, should owe their entire existence to these plans alone ; and this I shall endeavour to. show. Of Permanent Stricture . What I understand by stricture in the urethra, of a permanent nature , is an evident diminution in the capacity of that canal, in consequence of some substance being gradually added to it ; and although, from certain bodies irritating these parts, even this obstructing substance should suffer considerable contraction and relaxation, yet the canal at no time can return to its natural dimensions, till this ob- structing body be completely removed. In every period in the history of the venereal di- sease, the existence of permanent stricture in the urethra, has always been, among the better inform- 51 ed part of the medical profession, conceived to be very rare. From time to time, however, men of considerable ingenuity and address have started up* who have judged it either right or convenient, to maintain a very different doctrine. In short, there is perhaps no disease, the existence of which has been so often, in a great measure, doubted, and so often conceived frequently to follow one or other of the stages of gonorrhoea or gleet, or to be the consequence of treatment adopted for their remo- val. Now, although Mr Hunter informs us, in p. 112 of his book on venereal complaints, that perma- nent strictures are generally attended with gleet ; he does not by any means conceive this to be a diagnostic symptom, on which we are, without fur- ther investigation, to proceed to the use of caus- tic. But Mr Home uses less ceremony ; for, with- out any other symptom, or at most that of a slight spasm only, he introduces the caustic into the ure- thra Sometimes in one, at other times, in from fifty to a hundred applications, he arrives at the blad- der ; the inflammation occasioned by this process* removes the gleet, which might certainly have been cured by much easier means. From this success, however, such as it is, the disease is termed stric- ture, published as such, and is in this way believed to exist much more frequently than it really does. It cannot be too strongly inculcated, that per- manent strictures, as they are termed, as well as spasmodic ones, are by authors asserted to be most commonly found about the curve of the urethra! ! This is evidently to that part, from its curved shape, being in the urethra of every person, most likely to obstruct the progress of the bougie, in our attempts to introduce it into the bladder. I think this, at least, a highly probable conjecture ; and I have no hesitation in asserting, that the bougie thus arrested, or by its accidentally being obstructed by d 2 52 one of the lacunas, has, in many instances, given rise to the supposition of stricture in these parts, and led to a painful and tedious train of the most cruel practice. In giving an account of the dissection of those said to have died, after the removal, by caustic, of permanent stricture ; there seems to be nothing in the cases which Mr Home and others have adduced, to prove that permanent stricture ever existed in the majority of them. The parts said to have borne the marks of stricture, might be, and I am convinced many of them were, alone produced by the cauterizing effects of the appli- cation employed , not the disease which it was ap- plied to remove. It is very worthy of remark, that the existence of caruncles and excrescences, for- merly as much in fashion as permanent strictures now are, seems very doubtful. We all know, that mucous membranes in general, such as the lining of the mouth, Sec. when ruptured from any cause, do not form such appearances ; on the contrary, the parts are speedily regenerated, and assume their healthy action. The existence of these caruncles, excrescences, See. has been at length disputed, and the same symptoms are now imputed to permanent strictures Mr Home is quite aware of this fact ; p. 104, he acknowledges, that, “ if anyone will take the trouble to compare Daran’s cases, with those mentioned in this treatise, he will find that they cor- respond in the number and situation of the obstruc- tions, and only differ in the names given them ! /** A difference exists, however; Daran and his con- temporaries removed them without caustic : Mr Home and his followers cannot do this without fighting their way into the bladder, by the destruc- tion of every thing that can oppose them. But the multitude must be amused, they must have a tub ; yet it is truly strange, that the sufferings necessari- ly inseparable from that, often unnecessary ! un- 53 meaning, and always cruel practice, should be borne. That such a disease as permanent stricture in the urethra does exist, will not admit of doubt ; but that it exists much seldomer than most authors who write on the subject seem to wish to persuade us, is equally true. I am sorry to be obliged to say, that great advantage appears to be taken of an opi- nion too generally prevalent, that this is a disease of very frequent occurrence, almost every one who can write, publishes about it, throws out some al- lurement, by which perhaps he becomes a favourite of the public, and thus the unfortunate patient’s health, if not his life, is too often made the sport of chirurgical fanaticism. Cases of gleet, of spasmodic stricture, and of de- bility of the generative organs, are, in practice , con- stantly confounded with each other, and for the most part treated as permanent stricture. In the numerous volumes of those who have written on this subject, innumerable instances of this sort are to be found ; which, to particularise individually, would be a much easier than a pleasant task. We find on record, that caustic has frequently been applied in cases where, at the commencement of the patient’s passing water, it flowed in a full stream, but nearer the termination of that process it became smaller, twisted, and often forked. Now, had there been permanent stricture here, why did urine even at first pass in a jull stream P It must be evident, therefore, that no such obstruction existed. Thus, not unfrequently, the wretched patient had often entailed upon him, by the incorrect judgment of his surgeon, an incurable disease ; and this cruel practice was either persevered in, or he was at length dismissed, with an assurance, that he cither laboured under diseased prostate gland, or thicken- ing in the coats of his bladder , or something else, God knows what, which could not be cured ! To D 3 54 be reduced to such a state is particularly aggrava- ting, when, by more rational, and much less pain- ful treatment, the original disease might have been entirely removed. Permanent stricture may be induced by a bruise, caustic bougies, or similar applications ; never, as has been too often incorrectly asserted, in conse- quence of gleet, incontinence of urine, &c. &c. Except in the false statements of those who write on strictures, we have no analogy elsewhere in the human body, of parts uniting but in a certain state of inflammation ; and when that is reduced below* a certain degree of action, permanent stricture can- not take place. In this state, however, spasm of the parts is a very common occurrence ; indeed, it is only in such a state that spasm in general can take place, at least, to such a degree as to constitute those very obstinate cases of this disease, which we so frequently meet with. This spasm, continued very strongly for a length of time, causes some de- gree of inflammation, or it may be caused by a large simple bougie, or by caustic applied under these circumstances, which removes the torpidity of the parts, by inducing inflammation. This, how r - ever, with more safety, might have been removed by other and safer means. Thus, inflammatory ac- tion being produced, aided by strong, and often vi- olent spasm, a permanently contractile pow ? er of these parts, and permanent strictures, are at length the consequence. All membranes also, as well as the cellular sub- stance which joins them to the contiguous parts, are often indurated and thickened, in consequence of previous continued inflammation ; this happening to the membrane of the urethra, is one form of stricture which occurs independently of muscular action, and to explain which, we stand in no need of hypothesis. 55 Permanent strictures, then, may be produced, though not very commonly, by severe inflammatory action, however induced, being brought on these parts, in consequence of long continued disease. I may observe, that the disease called phymosis, or a contraction of the prepuce, so as to prevent its being drawn back over the glans, gave me a more perfect idea of permanent stricture, than any other circumstance ; and, previous to my observing this disease from its commencement, I conceived it a strong proof of the probability of permanent stric- ture being a very common disease, I however found, on carefully attending to its first progress, that its dilatation was easily effected ; and when this practice was adopted, the contraction seldom arriv- ed to any degree of severity ; but, when allowed to take its course, it almost always required to be cut, dilatation seldom being capable of effecting a com- plete cure. Strictures, when they do exist in the urerhra, oc- cupy it all round like a thin membraneous parti- tion of various breadth ; they may, however, be confined to any particular side of the urethra, or they may exist by a thickening of the mem- brane, or of the parts immediately below it, as sta- ted above, to the extent sometimes of an inch. Tu- mours also in the neighbouring parts, from various causes, occasion a greater or less degree of contrac- tion in the urethra, which is certainly permanent while these tumours exist. In the commencement of any obstruction in the canal, however slight, from whatever cause, the di- ameter of the canal being less or more narrowed, the patient must be sensible of its existence. Mr Home conceives it difficult to ascertain the exis- tence of obstruction ; unless the patient has been attentive to the usual healthy dimensions of his stream of urine. When we hear such reasoning adopted, were we not all acquainted with the usual D4 width of those parts, we would be apt to imagine the canal of the urethra to be as wide as a port- hole of a seventy-four gun ship, where the narrow- ing of a few inches would scarcely be observed ; but when we consider that this is not exactly the case, even independently of Mr Home’s having fa- voured the world with engravings of it distended with boiling wax, to at least one third beyond its natural size, — when, I say, we reflect on this, we are at once convinced of the impossibility of such a narrow canal being in the smallest degree obstruct- ed, without occasioning a sufficient portion of the patient’s attention, to make him at once apply for assistance. Some degree of spasm may, however, still conti- nue for years in the part permanently contracted ; but this can never be reckoned a consequence of the permanent contraction, but only a degree of the cause still existing, which probably at first ac- tually produced that permanent contraction. It seems, however, that writers on this subject take quite a different view of it. They seem to conceive the spasm in this case to be a sort of symptom, or an attendant on permanent stricture. Here it is at least not amiss to observe, that the greater the uniformity of opinion that exists on any imperfect sub- ject, the more tardily does it advance towards perfec- tion ; while to difference of opinion we are indebted for many of our most valuable truths. Mr Hunter also seems to labour under some con- fusion, in talking of the spasmodic affection, which sometimes attends what he terms permanent stric- tures : He observes, in page J34, that “ there is sometimes this singular circumstance attending these cases, that when there arises a gonorrhoea, or any other discharge of matter from the ure- thra, where none was before, or an increase of the old gleet, the passage becomes so free, as to allow the urine to pass as usual ; but these are uncertain, 57 and only temporary reliefs ; for whenever the dis- charge ceases, the spasmodic affection returns. I think it more prgbable, that it is only the spasm that is affected by the discharge, and not the real stricture and he was right, for it is obvious that, under the above circumstances, no such thing as permanent stricture could exist ; if indeed there really was such a thing, it must have been very slight, otherwise no alteration but its entire destruc- tion could at any time have allowed the urine to pass as usual . At all events, the spasm here must nave been the principal disease, and might have been re- moved by proper applications, not by caustic . Enlargement of the glands of the urethra, which are assuredly most common in scrofulous habits, act, while in that state, in some measure, as foreign substances, causing permanent diminution, irritation in the neighbouring parts, and often violent spas- modic action. Under these circumstances, in our present deficiency of knowledge by which glandu- lar swellings are removed, I conceive the very worst cases of stricture, either spasmodic or permanent, to exist. We may alleviate either of these affec- tions ; but, from what I have stated above, a cure, in our present state of knowledge, is scarcely to be expected. Glandular swellings in these, as well as in other parts, is a subject on which much is yet to be done. Of Fistula in Perinceo. Although by fistula in perinoea, is in general meant a sinuous ulcer in the perineum, by which the urine passes ; it sometimes does not stop here. In some cases of long standing, there exists a se- 58 ries of callous openings, from the anus to the scro- tum. The scrotum itself is sometimes affected with these sinuous openings, and sometimes the urine, finding its way into the cellular substance, penetrates deeply, and makes an opening in one or more parts of the thighs. Although, however, several fist ulae may appear externally, they seldom, if indeed ever, owe their existence to more than one opening in the inter- nal membrane of the urethra. A fistulous opening of this sort may arise, either in consequence of local injury destroying the or- ganization of the part, or from general causes, such as lues venerea. But this disease is most com- monly caused by a greater or less degree of obstruc- tion in the urethra to the natural passage of the urine. The parts posterior to the obstructed por- tion are gradually distended, the membrane is at length ruptured, and the urine, finding its passage into the cellular and spongy portion of the penis, is thus the cause of swellings in the perineum. These at length terminate in one or more fistulous open- ings, through which the urine flows ; and also of occasional discharges of foetid matter. Fistula iri perinoeo is sometimes caused by the ex- istence of an ulcer in the urethra. The urine, in such cases, finds its way into the perinoeum, a tu- mour is formed, and this most commonly termi- nates in a fistulous opening, through which the urine passes. At other times the urine passes into the cellular substance of the penis, and, without forming a distinct protuberance, will gradually stretch the whole integuments, and the scrotum, to a very extraordinary extent. A mortification of the parts, and even the death of the patient, is not, in such cases, unfrequent. If this state of disease be taken at a very early period, the patient may reap some advantage from our ex- ertions, but from the immense distortion of parts. 59 which soon takes place, little or no benefit is to be expected at a later period Although, however, the urine may force a pas- sage through the perineum, the natural passage, the urethra, is seldom, if ever, totally obliterated. On the approach of this disease, pain is felt in the perineum. The part next becomes inflamed externally ; a red hard tumour is formed ; and this, among those unaccustomed to the treatment of such complaints, is not unfrequently. mistaken for an ab- scess. This tumour at length often becomes as large as a hen’s egg, assumes a shining appearance, and the skin seems ready to burst. Even under these circumstances, however, it disappears on the application of cold or other causes ; but soon again assumes its previous appearance, and at length it discharges its contents, which are found to be urine. 6o General Observations respecting the following Class of Diseases . The generative system in women is particularly liable to such diseases as do not abate, when the cause which produced them is removed. Indeed, as much, and in many instances, more so than any other organ, or set of organs, entering into the formation of the animal body. We find in different women, that, from various cir- cumstances, the same cause produces very different affections of these parts. One is affected with chlo- rosis, or amenorrhoea, another with dysmenorrhoea, or with menorrhagia, while others are affected with leucorrhoea : On the same principle, that in both sexes, certain external circumstances such as cold, will in one produce catarrh, while in others it will pro- duce bowel complaints, rheumatism, inflammation, &c. These diseases, too, from causes which there may be some difficulty in explaining, sometimes change from one form to another, and often exist compli- cated and combined with each other. These seemingly different diseases, then, although in appearance different from each other, and con- sidered as such by every author, nearly or entirely arise from the same cause, and indeed are literally the same disease; only in different women, or in the same woman at different times, they assume the va- rious forms which I shall enumerate. Whatever may be the original cause, either of chlorosis, dysmennorrhoea, leucorrhoea, or of me- norrhagia, we uniformly observe that they all at length tend to debilitate the system in general ; and the same reasoning which is applicable to one, is, when rationally, and, of course, properly consider- ed, equally so to the rest. I shall consider Leucorrhoea first, as being the most common of these diseases. 6i OF LEUCORRHOEA. Definition of the Disease . Systematic writers have defined this disease va- riously. Sauvages defines it to be “ a yellow serum, or puriform matter, flowing from the uterus.” Vogel, that it is “ too copious a discharge of mucus, or ichor, from the female parts of genera- tion.” Sagar, that it is cc a serous, yellow, puriform, mu- cus, foetid, dark, & c. matter, poured out from the uterus or vagina.” Cullen, though he has given leucorrhoea no place in his synopsis, treats of it in his first lines, as a flow from the same vessels, which, in their natural state, pour out the menses. I shall endeavour to show, that leucorrhoea, is a discharge of depraved mucus, from the internal surface of the uterus or vagina, or from both. Nature and Seat of the Disease . Authors not only disagree with regard to the nature of the discharge, but with regard to the parts whence it flows. 6 2 It is essentially necessary, however, to draw some definite conclusion concerning these points. Those who suppose the discharge to be poured out by the menstrual vessels, denominate it se- rous ; but that this discharge is generally, or even ever, precisely the same as the serum of the blood, has by no means been proved. If, however, we were entitled to judge, from the sensible properties of the matter, and the changes both of colour and consistence which it undergoes, we should pronounce it not to be serous, but the same as that from any diseased mucous mem- brane. But as the passages from different organs termi- nate in the vagina, and as both these organs and their canals may be differently affected, so there may be discharges different in their source and na- ture, all ultimately appearing in their cavity. A discharge, besides, may pass from the urinary organs, through the urethra to the external orifice of the vagina, or it may proceed from the vagina itself, from the uterus, or from both ; and it may come immediately, either from the interior surface of these organs generally diseased, or from limited ulcers, tumours, or cancerous sores situate in them, or communicating with them. It is worthy of remark, that * pus, formed in an abscess of one of the ovaria, has descended through the fallopian tube into the uterus, and thence through the vagina, but this is a rare occur- rence. Of these facts, any one may satisfy himself, by consulting Morgani’s invaluable work, De Sedibus et Causis- Morborum : it would be tedious and un- necessary to give instances of all of them individu- ally. No one, however, by leucorrhoea, understands a * Act. Paris 170Q, Obs. Anat. 5, 63 discharge either from the urinary organs, or from an abscess, ulcer, cancerous sore, or tumour of any kind, in these situations. In the leucorrhceal dis- charge, the organs of generation are understood to be principally concerned ; the only difference of opinion being about the parts of these organs, which are the seat of the discharge, or the peculiar vessels which produce it. Some, as their definitions show, erroneously as- cribe it to the uterus alone ; others, to the uterus and vagina. Those who think that it proceeds from the men- strual vessels, will of course ascribe it to the uterus; but those who think that it proceeds from the mu- cous membranes, will be of opinion that it may pro- ceed either from the one or the other, or from both of these organs. In Dr Cullen’s practice of physic, he treats it in a very brief, very hypothetical, and very unsatisfac- tory manner; though the disease is a source of the utmost calamity to an immense proportion of the fair sex, married and unmarried, at once destroying the health of the unfortunate sufferer, and every hope of progeny. He is one of those who presumes that, in leucorrhcea, the discharge proceeds from the same vessels which, in their natural state, pour out the menses. I shall, therefore, consider the ar- guments which he has collected in favour of his opinion, and endeavour to ascertain how far they substantiate it. He concludes the discharge to be of this kind : 1st, From its happening to women who are subject to an immoderate flow of the menses, and liable to this from causes weakening the vessels of the uterus. 2d, From its appearing chiefly, and often only, a little before, as well as immediately after the flow of the menses. 3d, From the flow of the menses being diminished in proportion as the leu- corrhcea is encreased. 4th/ From the leucorrhcea 64 continuing after the menses have entirely ceased, and with some appearance of its observing a perio- dical recurrence 5th, From the leucorrhcea be- ing accompanied with the effects of the menorrha- gia, (§ 07 2-3.) 6th, From the discharge having neither been preceded by, nor accompanied with symptoms of any topical affections of the uterus. 7th, From leucorrboea not having appeared soon after communicating with a person, who might be suspected of communicating infection, and from the first appearance of the disease not being ac- companied with any inflammatory affection of the? pudenda.” Now, if we examine these arguments individual- ly, we shall not find that they warrant such a con- clusion. cc 1st, From its happening to women who are subject to an immoderate flow of the menses, and liable to this from causes weakening the vessels of the uterus.” But two discharges from the same organ, or from the same surface, afford no proof, that both are poured out by the same vessels : nor would the ex- istence of debility lead us to conclude that it affect- ed only one species of vessels. By such modes of reasoning, we might conclude, that the discharge of semen and gleet, in the male, proceeded from the same vessels, since this sometimes happens to men who are subject to immoderate flow of semen, and who are also liable to this from debilitating causes. The different species of minute organs, inces- santly operating in all organic surfaces, external and internal, are each susceptible of disorder; and the same debilitating causes will, according to their difference of structure, affect them differently. Those vessels which produce mucus to labricate the parts, must he debilitated and dilated by the same causes which debilitate and dilate the blood- 65 vessels of the uterus ; and if such debility and dila- tation increase the flow of blood, however altered or modified, from the minute vessels, from which the menstrual discharge proceeds, it may equally encrease the discharge from the disordered muci- parous glands. And when it is known, from actual observation, that not only the uterus becomes weak* spongy, and flaccid, towards the approach of men- struation, but that the whole system is sensibly en- feebled ; we shall not be surprised, that about this time the mucous discharge should be augmented. Accordingly, we can easily perceive how the leu- corrhceal discharge should, (as the Doctor 2dly observes), appear, “ chiefly, and often only, a little before, as well as immediately after the flow of the menses,” and yet may have a totally different ori- gin. That which may cause the apparent increase of the leucorrhoeal discharge, shortly before and after the flow of the menses, is, the circumstance that, even in health, the menstrual flux is both pre- ceded and followed by a serous discharge, which, mixing with that of leucorrhoea, may, at such time* give it an appearance of temporary increase. That which will much invalidate the second reason adduced by the Doctor, is, that the leucor- rhceal discharge is aggravated at any time between the menstrual periods, and consequently indepen- dent of them, by passions of the mind, by hysteric attacks, by fatigue, See . ; and that the disease hap- pens even before puberty, when the vessels neither do, nor ought to pour out the menses. The 3d argument, “ From the flow of the men- ses being diminished, in proportion as the leucor- rhoea is increased is strangely in exact opposition to the first, — “ from its happening to those subject to an immoderate flow of the menses and also to his opinion, that “ that flow of the menses may ge- nerally be considered as immoderate, which is pre- ceded and followed by leucorrhoea and it is even E 66 contrary to experience ; for the menses do not, when leucorrhoea commences, necessarily diminish either in quantity or in duration, but are on the contrary, often more copious, of longer duration, and in every respect more distressing than in health; and indeed the Doctor himself elsewhere tells us, that it is sometimes accompanied with a consider- able degree of menorrhagia, producing very re- markable effects and, it is a fact that, in propor- tion as the leucorrhoea is removed, the menses re- turn to their wonted limits, both as to time and quantity. Though leucorrhoea even continued after men- struation, that circumstance would not indicate that they were both execreted from the same vessels ; for the leucorrhoea might be expected to continue independently of the menstruation, and the appa- rent consentaniety of both, might be owing to the periodical return of that delibity which is absolute- ly necessary to the existence of both That there may be an increased discharge of se- rum from those vessels which pour out the menses, I am not inclined to question ; for it is not difficult to believe, that the serous flow, which both pre- cedes and follows the menses, may, even at other periods, be occasionally augmented in a very great degree, just as the menstrual discharge itself is ; or even that this discharge may at one time be more diluted with serum than at another. And if I were allowed to conjecture, I would say, that it is proba- ble, that those leucorrhoeas, if they may be so term- ed, which observe a periodical recurrence, are of this nature ; but that such a discharge is the one which constitutes the characteristic symptom of the fluor albus, properly so called, facts will not permit us to suppose for a moment. That leucorrhoea produces the same debilitating effects as menorrhagia, does by no means indicate that both discharges proceed from the same ves- sels ; it only shews, that the two complaints affect 67 the general constitution in a similar way. Many other diseases, very different from one another, pro- duce nearly the same effects on the general system, and, in this respect, menorrhagia and amenorrhoea agree. That the discharge is not preceded nor accom- panied with symptons of any topical affection of the uterus, shews, that the disease comes on some- times when we do not expect it, but, by no means, that the discharge proceeds from the same vessels. Nor can this be rendered probable, by the dis- charge not succeeding venereal infection, or local inflammation, any more than that the discharge of gleet in males should proceed from the seminal vessels, when unpreceded by gonorrhoea. But there are many facts which shew, that the leucorrhoeal discharge does not proceed from the vessels which give out the menses. The discharge is precisely similar to that which appears when the mucous membrane of the urethra in the male is in a state of disease ; such discharge is not necessarily present in menorrhagia. Leucorrhoea does not seem, by any immediate connection, which it might thus have with the menses, decidedly to render the uterus unfit for the purposes of generation ; since some women slightly affected with it bear healthy children ; and others, though very much distressed by it, have yet living children at the proper period of parturition ; the children of the latter, however, so far as my oppor- tunities of observation extend, are in general delicate. The bad effects of leucorrhoea, on the production and nourishment of the foetus, may all depend on the general disturbance of the functions of the ute- rine system ; and this is corroborated by the fact, that this disturbance is not perceptible, till the dis- ease is far advanced, which would certainly sooner manifest itself, if the vessels, whence flow the men- ses, were primarily and chiefly concerned. That E 2 68 It is not confined to the uterus, is decidedly proved by this, that, after pregnancy, when the mouth of the uterus is shut, the leucorrhceal discharge is of- ten more copious than before conception The celebrated Hoffman, # to whom Dr Cullen acknowledged himself much indebted, very con- cisely states most of these facts. “ This flow does not follow any certain rule with regard to time or duration ; in some, it is incessant; in others, it re- turns twice or thrice a month; and there are instances of it observing, as it were, stated periods. It is found to precede, accompany, follow the menstrual discharge, or even seems to be substituted for it. Women advanced in life, beyond the time of men- struation, are not exempt from it ; and it is present during the whole time of gestation.” Now this discharge is often so acrid, as to ex- coriate the pudenda and thighs ; and what dread- ful consequences should we not have reason to expect, if this acrid matter occupied the vessels which pour out the menses ? For, even according to my opinion of its being an affection, in which the mucous membrane is immediately concerned, we have no other resourse than to suppose, that some of the muciparous glands are still capable of preparing and furnishing healthy mucus, which may defend the internal surfaces of the uterus and va- gina from the action of such a discharge. In addition to these general reasons, we have the demonstrative evidence of dissection and actual ob- servation, that the flow does not always proceed from the uterus alone ; and that frequently the internal surface both of the uterus and vagina is concerned in the production of the discharge ; and sometimes, as already shown, those of the vagina alone : where- fore it cannot, in such instances, be produced by the same vessels which in their natural state pour * Med. Rat. Syst. t. 4» page 4. c. 16* Thes. Pathol. § 23. 6g out the menses. If to this we add, that the purely serous discharge is not established, by one well as- certained fact, to have proceeded solely from the vessels of the uterus, so as to constitute this disease ; we must conclude, that such is at most but a rare occurrence, and is bv no means the affection ge- nerally called leucorrhcea. I know that attempts have been made to recon- cile the contradictory fact and supposition ; the fact, that the fluor albus proceeds from the vagina in pregnancy, and the supposition of its being poured out by the menstrual vesssels The vessels, it is said, of the uterus and vagina, are connected by very numerous anastomoses ; and hence, when the uterus is closed, the serum flows. * But this is so absurd an explanation, that it re- quires no refutation. This reasoning is somewhat analagous to that, which more lately suggested an absurd enough practice for the cure of amenorrhoea, which consisted in applying pressure to the femoral vessels, to produce menstruation. Did they not perceive, that if nothing more were concerned in menstruation than the mere loss of blood, that the monthly use of the lancet would obviate all the bad effects of suppression ? The use of the lancet even for this purpose was recommended by Dr Fothep- gill ! f In Duncan’s Commentaries, there is a case relat- ed, which shews, that the leucorrhceal discharge sometimes proceeds from the vagina alone, and that the catamenia proceed from the interior sur- face pf the uterus. A woman, who had long laboured under prolapsus uteri, was at last attacked also by the fluor albus ; and it was observed in her, that the menstrual dis- * Trnka, Hist Leuc pars 1, § 15, p. 47. •f Vid. Med. Obs. and ing. vol, v. p. 180# E 3 70 charge came through the os uteri, but the leucor- rhoeal always from the vagina. * That both the interior surface of the uterus and vagina may be concerned, these, with the following facts from Morgagni on the leucorrhcea, will amply prove. f He squeezed the white matter of fluor albus from different parts of the interior surface of the uterus. J In a virgin, who died at the age of fourteen, were found tubercular swellings on different parts of the viscera, and a very thickened portion of the omentum adhered to the fundus uteri. The uterus was very small. The capacity of the fundus was full of a white humid matter, verging to a yellow or greenish colour. Minute whitish tubercles ap- peared on its anterior surface, but none at the bor- der of the os uteri. The vagina and hymen were inflamed, from the matter, no doubt, of the dis- charge. || In another case, greyish white matter was found in the cervix uteri and vagina ; the blood vessels of the fundus gave an appearance to the membrane, similar to what the Schneiderian would evince in consequence of cold. And he adds, that both an- cient and modern physicians reckoned these effects very similar to each other. I have, however, no hesitation in stating the va- gina to be the common source of the disease. We might, with equal plausibility maintain, that the puriform matter occassionally discharged from the cavities of the lungs, fauces, and nose, is poured out by the same vessels with the blood in epistaxis and hymoptysis, as that the menstrual and leucor- rhoeal discharges proceed from the same vessels. * Commentaries, vol. iv, p. 88. f Morgagni, Epist. XLvll, $ 1 2. Idem, § 14. || Idem, Epist, lxvii. 71 It is of importance to observe, that a great pro- portion of women have been taught to believe that leucorrhoea is a natural discharge, the existence of which is, for the most part, absolutely necessary to the preservation of health ; and if their health be already considerably impaired by it, the old and ex- perienced matrons most fatally console themselves and others in the supposition, that to this discharge alone they owe the little health they possess. It is not therefore to be wondered, that women often so strenuously deny being affected by it. Of the Source of the Leucorrhoea! Discharge . As it appears established, that the leucorrhoeal dis- charge proceeds from the uterus, and more especially from the vagina, or from both, in consequence of an affection occupying, to a greater or less extent, one, or other of the internal structures of those parts, or both of them at the same time ; and that discharges, from other sources, or caused by other diseases seated in the same parts, may be mistaken for the leucorrhoeal ; but we may, by a little attention, easily distinguish the latter from the former. It may be difficult to determine, whether the discharge proceeds from the vagina alone, or from the uterus, or from both. When there has been no disturbance in the func- tions of the uterus ; when the general health is good, or not evidently suffering much ; when the functions of the stomach, which so sympathetically participates in the morbid affection of the uterus, remain unimpaired ; we have reason to think that the vagina is chiefly in fault, and vice versa . 72 Bat if the disease have altogether another source, and proceed from the urinary organs, we may dis- cover, by the functions of the bladder being dis- ordered, by pain in passing water, the discharge being much increased in rising from a horizontal posture, the appearance of the urine, and the dis- charge always disappearing for sometime after the passage of the urine. When the case is, as very frequently happens, rendered complex, by the presence of other affec- tions, we must judge of these, as well as of their magnitude and importance, from the additional symptoms which manifest themselves. Many facts detailed throughout this work will convince any one, that the discharge is often only a concomitant symp- tom, or comparatively insignificant addition to af- fections which may hold in contempt the dexterity of art, and almost convert into folly the ingenuity of science. The two following cases, which lately came un- der my observation, as illustrating these varieties, are worthy of notice. A young girl, aged 1 6 months, after suffering severely from an inflammation in the left groin, which rapidly became of a livid color, suppurated, burst, and became an ill-conditioned ulcer, was af- fected with swelling of the labia pudenda , and had puriform matter discharged both from the ulcer and from the parts of generation. The ulcer was kept clean, dressed with ung. alb., and cathartus were given ; but still the ulcer increased in size, and became puckered, irregular, and thick in the edges. On examining the child’s mouth, several of the teeth were felt distinctly almost through the gums, which being freely opened, the child soon after seemed much relieved. The ulcer was still dressed as lorpaerly. 73 Speedily the ulcer in the groin assumed a healthy appearance, the inflammation was greatly reduced, and not long after, it was completely healed. The state of the teeth was evidently the cause of this complaint. Another young lady, aged five years, had, for several weeks, been affected with violent inflamma- tion of the labia pudendi, with great swelling, dif- ficulty of voiding urine, and a plentiful discharge of puriform matter from the parts of generation. The parts became livid and acutely painful, but there was no external ulceration. Cathartics were given, and emolient poultices were applied, before J saw the child. On examining the mouth, I found that the child had the full number of teeth for one of her age By a continuance of the treatment men- tioned above, the inflammation, swelling, and pain in voiding urine, gradually abated, and, in about ten days, entirely disappeared. The discharge from the parts of generation continued about a week more, when it likewise went away. Causes . There is not a power that can debilitate the hu- man irame, but has been, and perhaps truly, reck?- oned a cause of this complaint. Those circumstances, however, that contribute most immediately to its production, are such as debilitate the uterus itself, viz. difficult labour, abortions, and uterine hemorrhagies ; to which may be added, inflammation, and whatever can induce subsequent atony of the membranes investing the vagina and uterus. As to the suppression of the mucus discharged from the nose, or even that of the secretion of milk 74 in the mammae of nurses, which have been num- bered among the causes, they seem scarcely worthy of notice. The disease is denominated leucorrhcea, floor al- bus, or whites, from the appearance of a certain fluid matter discharged per vaginam ; which is the characteristic symptom of the affection. In addition to the discharge, the patient com- plains of severe pain of the back and pubis. Pains of different degrees of acuteness and continuance, also extend along the spine, the loins, and are oc- casionally felt in the head, in the stomach, in the intestinal canal ; in the kidneys, bladder of urine, uterus, and in one or more of the joints. The abdomen is tense, hard inequalities are often felt in different parts of it ; and, lassitude, debility, and sluggishness, are generally remarkable. The pulse is from 80 to 100, or 120, per minute; feeble, sometimes irregular, or even intermittent. The patient is oppressed with a sense of weight in the cervix uteri, so that she feels easier when sitting with the knees drawn upwards. She sleeps but little, and even that little is disturbed by fear- ful dreams, and is far from refreshing. The general health and external appearance suf- fer apace, though near the commencement of the disease, and even for a long time of its course, this is not very perceptible. She generally looks pale and emaciated, her eyes are generally dull, and streaked with a dull red, and have a blue semicircle under them ; there is a cer- tain softness, a sort of puffy swelling and bloated appearance over the whole body, in this respect re- sembling chlorosis. In the progress of the disease, the skin assumes a yellow taint ; the feet and ankles swell toward evening. Some, or all the functions of the body., become less or more disordered, appearing variously 75 in different individuals, and at different times dur- ing the disease. Her mind is very dejected, very apprehensive, very easily alarmed, and affected with deep melan- choly, She is extremely peevish, fretful, irascible, and anxious. She feels oppressed about the precordia, is trou- bled with slight cough, dyspnoea, and pain on full inspiration, with palpitation and fainting, particu- larly on the body being suddenly moved, or the mind in any way alarmed. The affections of the stomach and intestinal ca- nal are generally present during the whole course of this complaint ; these are want of appetite, de- praved digestion ; in short, all the symptoms of dyspepsia, with sickness in the morning and even- ing and vomiting. The bowels, for the most part, are obstinately cos- tive, but sometimes there is a severe dysenteric at- tack, succeeding the constipation. The urine is turbid, and the bladder is often much affected. The menstrual discharge is frequently too copi- ous, irregular and discoloured ; sometimes scanty, or even suppressed, as shall subsequently be ex- plained. This last occurrence has been followed by very singular symptoms, for to the suppression of men- ses, we are assured that there often supervene hae- moptysis, dysentery, hcematuria, inflammation, schirrus, many affections of the viscera ; and there is not only epistaxis, but discharges of blood from other parts, as the meatus auditorius, the points of the fingers, &c. The disease is sometimes cured spontaneous! v, b) some change or revolution in the system, mani- fe^ ;ug itself in critical evacuations, as copious sali- vation, diarrhoea, sweating, vomiting. 7ft It is said to have been sometimes, though rarely, removed by puberty and conception. But when it is not removed by nature or art, it proceeds to waste the constitution with accumulat- ing mischief. All the calamities above detailed are aggravated. The eyelids and face at length swell in the morning, the legs and feet in the evening ; the body is astonishingly meagre and debilitated, and now, in the last stage, hectic fever, with all its dire attendants, and dropsy in every form, su- pervene, and terminate the miserable scene. Hysteria, in a greater of less degree, generally precedes and accompanies the disease through its course. The greater number of those symptoms are com- mon to this, with the other affections in which the uterus is, or appears to be, concerned. The disease is said to have affected females of every age, even infants at birth, and I have known it to affect them shortly after, and to continue for many years. It sometimes attacks severely, during pregnancy, those who are slightly affected with it when not in that state ; and there are instances of women being attacked with it only during pregnancy. After it has continued for some time, the function of generation is disturbed, and it is not an uncom- mon cause of sterility. it has observed all the varieties of duration, from a momentary attack to that of 30 years or more ; in general, however, leucorrhcea is very obstinate, and not unfrequently defies all the powers of art. Discharge . The discharge is sometimes continued, some- times intermitted ; varies in quantity at different 77 times, and according to different circumstances ; is more copious in winter than in summer, is also more copious a day or two before the flow of the menses, than during the rest of the interval be- tween the period of their appearance. But the quantity is occasionally very abundant, or the contrary ; being influenced by passions of the mind, and every thing that in the least sheets the state of the body. The matter of th discharge assumes a great va- riety of appearances, according to the state of the parts from which it proceeds, and more or less, that of the general habit conjointly. It is at one time clear, limpid, viscid, or glairy ; at another, white, green, yellow, brown, or of mix- ed colours, sometimes it is completely puriform. When the disease is far advanced, it becomes sanious, ichorous, acrid, shockingly disagreeable to the sight and smell, and excoriates the uterus, va- gina, labia pudendi, and thighs. In the discharge there sometimes appear, parti- cularly in the last stage, fleshy tumours, detached coagulated substances, portions of membranes, the products of spacelation, and even animalcula resem- bling ascarides, are recorded to have been found in it. Sometimes the discharge stops spontaneously, and this is succeeded by very troublesome conse- quences, as pains in the hypogastric region, and head, fever and delirium ; ulcers break out on dif- ferent parts, which relieve these symptoms ; and, not un frequently, on such an occasion, acute, chro- nic, exanthemata, break out over all the body. Ery- sipelatous, and other eruptions, however, are not rare at any time during the disease. Dr Cullen’s hypothesis implies, that the leucor- rhceal is nothing else than the depraved menstrual discharge : But this is not only very improbable, from the circumstances above mentioned, but from 7S others ; the leucorrhoeal discharge has often all the appearances and properties of pus; are we therefore to suppose that the menstrual fluid ever assumes this form ? Distinction , &c. Some practitioners have deemed it of importance, to ascertain, whether the complaint originated from venereal affection, and was preceded by local in- flammation of the vagina, because, in these circum- stances, they would consider it rather as gleet than leucorrhcea. But between gleet, considered as a disease of de- bility, the principal symptom of which is a chronic, mild, glairy, or somewhat puriform discharge from the vagina, and leucorrhcea as an atonic complaint, there really is and can be no distinction, from what- ever cause they may have originated ; the medical treatment of both must be precisely the same, and" equally regulated by the same concomitant symp- toms. It will frequently happen, that we cannot deter- mine whether the complaint has arisen from vene- real infection, or not ; in most instances, however, we may judge with tolerable precision, from certain circumstances in the history. If the patient has been rather declining in health for some time, been troubled with stomachic affec- tions, pains in the loins, &c. ; has not been regular in her menses, either as to quantity, duration, or recurrence ; if the menses have either been preced- ed or followed, for some time, by an usually great serous discharge ; and there has, to these symp- toms, succeeded a thin, glairy, or even more or less puriform discharge, unaccompanied with heat or pain in the bladder or uterus, or their canals ; if 79 the patient has suffered from abortions, tedious or difficult labours, or is at that age when the men- struation must cease, in obedience to an immutable law in the animal economy, we shall be pretty safe in considering the complaint as a leucorrhoea, But if a woman, enjoying good health, is sud- denly attacked with ardor urinae, puriform discharge from the vagina, and other inflammatory symp- toms, the suspicion of venereal infection will be ve- ry strong. Still, however, let us hesitate before we pro- nounce an opinion ; we may stain the purity of in- nocence, and, to bodily sufferings, add those of the mind, from which the unfortunate individual may never recover. Though the suspicion be very strong, yet even this form of the disease may arise from many cau- ses, totally independent both of infection or coi- tion. Inflammation of the most active kind, seizes the female organs of urine and generation, quite inde- pendently of infection, and that even in infancy, as is shown by the two cases, page 72 ., when the time of life precludes the possibility of suspicion ; there is no accoucheur who cannot testify this. Young women are sometimes afflicted with such itchings, heat, and pain, in these parts, that they can neither sleep, sit, nor walk. The glands about the urethra, the clitoris, the labia pudendi, are discovered to be enormously tu- mifled, reddened, excoriated, and exquisitely sen- sible to the touch. Pus flows in great quantity ; the urine cannot be voided without excruciating torture ; and the complaint is completely remove- able by the common antiphlogistic means. In short, the membranes investing the vagina and uterus may be inflamed, though not by the poison of lues, just as easily as those investing the mouth; fauces, and lungs. so When the discharge has continued for any great length of time, the constitutional and local symp- toms are the same, from whatever causes the di- sease has proceeded ; and the cure is to be con- ducted in precisely the same way, so that the dis- tinction is not now of so great practical impor- tance ; but even here we sometimes form a pretty correct opinion, from enquiring into the history of the complaint. Even though a gonorrhoeal discharge, with or without excoriations of the prepuce and glans pe- nis, appear in consequence of connection with a fe- male, this is not complete evidence of venereal in- fection ; for this often happens to a husband, when his wife labours under leucorrhoea We have reason to believe, that, on such occa- sions, the rash and false judgment of medical men, has often been productive of irreparable mischief, blasting the reputation of an innocent wife, the con- fidence and peace of mind, both of her and her husband, and disgracing their innocent offspring. Affections combined with Leucorrhoea . There is not a disease which assails the female body, with which, according to authors, leucor- rhcea has not been connected in the relation of cause, concomitant, or effect. The affections, however, with which it is most frequently connected, are those of the uterus and its appendages; and among these we may number schirrus, cancer, tumours of various descriptions, indurations, and other affections of the vagina, ute r rus, and ovaria ; similar affections also of the blad- der and kidneys, paralysis of these parts, strangury, or dysury, and calculous affections. It often exists along with scirrhus, or cancerous 81 tumors of the mammae, and with some one of the herniae. In short, whatever greatly deranges, and greatly debilitates the system, is most apt to occa- sion it. In examining cases of this disease, we ought to ascertain whether there are tumors about the cer- vix uteri, or any of the parts that can be examined. In females advanced in life, and particularly a- bout the time of the cessation of the menses ; and in those who have cancerous affections of the mam- mae, we have occasionally reason to think that such tumors are present, from small fleshy bodies having been voided per vaginam When, without the evident symptoms of disor- der in the uterine functions, there has been great pain and irritation in the parts, unaccompanied by any discharge, with some other inflammatory symp- toms, more or less severe, and these at last abate, and a discharge of puriform matter appears, we have reason to think that an abscess has been formed. The following cases, treated by Mr Hey of Leeds, do great honour to the author. In April 1780, Mrs D. of S. about 20 miles from Leeds, consulted me on account of a very troublesome fluor albus, as she judged it to be* She informed me, that the disorder had come upon her about five years before, during pregnancy, and had hitherto resisted the effect of every remedy given for her relief. In answer to my enquiries, she gave me the following account of her complaint. “ The colour of the discharge was white, inclining to yellow. It flowed in an irregular manner, un- connected with any circumstance which she could recollect. Sometimes it began to flow suddenly in large quantity, and continued diminishing until it ceased. The parts were often rendered sore by the evacuation. “ From these circumstances, I suspected that the nature of the complaint had been mistaken, and * Hey’s Surgery, 1803. p. 486. F 82 was apprehensive, that a collection of purulent mat- ter might have been formed in the vagina. I gave her the reasons of my suspicion, and told her, that, in my opinion, the true state of her case could not be ascertained, without an examination of the parts affected. “ Upon examination, my suspicions were verified. I found a quantity of purulent matter collected on the left side, where the labium pudendi joins the vagina. I thrust the blunt end of a probe into the cyst, where it appeared to be very thin, and the matter flowed out very copiously. I informed her, that a surgical operation would, be necessary for her cure ; but she declined submitting to it, and return- ed home. “ I heard no more of my patient till May 1781, when she returned to Leeds, determined to put her- self under my care. The disorder had remained in the same state. The cyst was sometimes healed, and then bursting open, continued for a time to discharge the purulent matter as before. “ Upon dividing the cyst, I found that the cavity in which the matter lodged, was about an inch and a half in diameter. The whole interior surface of the cyst was smooth and shining ; and, on that ac- count, I judged it improbable that a simple divi- sion of the cyst would effect a cure. I thought it necessary, therefore, to remove the greater part of that portion of the cyst, which was formed by the internal lining or cuticle of the labium pudendi. The hemorrhage was inconsiderable, and soon ceased. The wound healed kindly, and my patient obtained a perfect cure.” “ In 1786, Anne Miller came under my care as an out patient of the General Infirmary at Leeds, for a node upon the tibia, which I suspected to have had a venereal origin. When she was about to be discharged, cured, she informed me, that she had been troubled for io or id years with sudden and 83 irregular discharges of purulent matter from the vagina. These discharges, she said, were frequent, and considerable ; yet she never perceived any mat- ter to be mixed with her urine. “ Upon examination, I found a roundish tumor at the os externum, appearing to be formed by an enlargement of the bulbous part of the urethra. When the tumor was compressed, pure pus issued from the urethra ; yet her urine did not contain the least mixture of purulent matter. Upon intro- ducing a bent probe into the urethra, I could easily push it into the most depending part of the tumor ; and could feel the probe distinctly by a finger in- troduced within the vagina. “ I divided the tumor longitudinally, at a time tvhen it was distended with matter. That part of the vagina which I cut through, was not thinned by distention, but was rather tough. The cavity of the cyst was smooth. As the opening which I made was depending, and as the removal of any part of the cyst would have been attended with difficulty, I only filled the cavity with lint. A small artery was opened by dividing the cyst, but the hemorrhage did not continue long. This pa- tient recovered speedily, and got quite free from the complaint.” When cancer is present, the symptoms are too tremendous, and too decisive, to leave any room for doubt. OF CHLOROSIS. The disease, termed Chlorosis or Amenorrhofca, is caused either by a suppression or by a retention f 2 S4 menstruation ; not appearing at the usual period, it is the cause of great distress. The features are, in this disease, tumified and inexpressive, and a paleness or yellowness, nearly approaching to a shade of very faint green, pervades the whole of it, while the eyes are dull and heavy. The body is flaccid, and the extremities are edem- atous ; weariness and pains are felt about the loins ; and the patient is totally unable to use the most moderate exercise without suffering the greatest distress. OF DYSMENNORRHCEA. Whatever may have been the original cause of what is called Dysmenorrhcea, in which the cata- menia flow with difficulty, and are accompanied with great pain, we know debility to be in general present to a great degee when that disease is vio- lent. Cullen, as usual thinks, that it depends on spasm of the extreme vessels of the uterus ; perhaps this may exist along with it, but I am sure that this is not the cause of it ; nor do I ihink his practice of prescribing opiates, though it remove such spasm, can possibly remove the disease. Hyociamus has been prescribed, which acts nearly on the same principle. OF MENORRHAGIA. Menorrhagia is an irregular, but at all times an increased flow ot blood from the parts of the ge- 85 neration of women, or it may simply consist in a remarkable increase of the menstrual fluid aone. But from whatever cause it arise, (for various causes may combine to produce this state) it uniformly tends to induce every symptom often of the most dangerous debility of the general system. All the causes of menorrhagia, assigned by Cullen in his first lines, such as a continuance of full and nou- rishing diet, much strong liquor, intoxication, vio- lent shocks of the whole body from falls, or con- tusions on the lower belly, violent exercise, violent passions of the mind, excess in venery, particularly during menstruation, a costive habit, &c. ; fre- quent abortions, frequent child-bearingwithoutnurs- ing, difficult tedious labours, living much in warm chambers, and drinking much warm enervating li- quors, such as tea, he treatment of them, I thought that little more would be necessary, than a relation of the cases that had fallen under my observation ; but, on considering the subject more fully, I was convinced that this 131 plan would be by far too limited. The complaints themselves not being previously sufficiently un er- stood, nor distinguished from others somewhat of a similar nature, with any degree of precision and ac- curacy, the indiscriminate use of the canthandes, for instance, might and certainly had been fraught with mischief; and, on many occasions* even in complaints of the same nature with those in which its use was indicated, other remedies might have been used with more propriety. Neither the prin- ciple of the operation of that medicine, nor the cir- cumstance^ of constitution in which they should be had recourse to, or prohibited ; nor the combina- tions of disease, which would frustrate our design in the administration of them, or which might en- tirely contra-indicate their use, and in which con- sequently their operation might be hurtful, — seemed to be understood. Besides, there prevailed preju- dices and fears against them, which it was necessary to confute, overcome, and remove. I found, also, that my own views with regard to this medicine became daily more extensive ; that its powers, in exciting the action of the living body, in extent, efficacy, and utility, far exceeded any thing that either I or any other human being could have expected, since by it we can maintain and regulate that action which is indispensibly necessary tor the accomplishment of the salutary purpose of their ad- ministration. Besides, the range of bodily infirmi- ties and affections, in which they evinced those generally stimulating properties, were not only very numerous, but such as other means were generally employed to cure without success. The previous paleness and debility, with want of ability for ex- ertion, and the soft flabbiness of the muscular parts, which previously existed, gradually disappear alter they have been used for sometime, and the patient becomes stout, and, in general, of a healthy ap- pearance, I 2 132 With regard to all the diseases; then, which I have detailed and which l shall point out as remediable by that medicine, innumerable circumstances show them to be purely those of debility. In a majority of cases, we can trace their existence to a previous overaction of the whole sanguiferous system, which is acknowledged by every one to be productive of debilitating effects. But more commonly they are such as depend on a similar overaction of this function in some particular series of organs ; most commonly of those of the generative system. In the latter case, it is, after the continuance of the disease, and during a considerable length of time, by no means an uncommon occurrence, for the ge- neral system to become remarkably affected with various forms of disease, all of which, varied as they may appear, can only be permanently removed by restoring the tone of the parts, the loss of which first occasioned them. The powers of digestion fail, and occasional vomiting is by no means un- common, and the bowels are in general constipated. The sight, too, and hearing, and memory, are, espe- cially in severe cases, very considerably impaired ; so much so, indeed, that I have known some pa- tients totally unable to follow any occupation, or in- dulge in any amusement, where the exercise of ei- ther of these faculties was absolutely requisite. Some, I may remark, think, that it is a great ar- gument against any substance employed as a medi- cine, when it is affirmed to be useful in very many complaints ; and for the most part indeed it is so, because empiries openly declare their particular nostrums to be good for all complaints, however opposite their nature. But it is a very different case, when the same substance is found useful in complaints which, though differing in name, from certain local circumstances, or in the parts princi- pally affected, are really or the same nature. This becomes a strong argument in its favour. 1S3 It is, I may mention, a melancholy, but well es- tablished fact in our profession, that the violence of opposition, which any improvement, either in surgery or medicine, meets with, is too often, at least for a considerable length of time, exactly in proportion to its importance in the removal of dis- ease. While, with the greatest facility, any mys- terious agent which can be proposed for the re- covery of health, is, without the least scruple or even attention to their too often fatal consequen- ces, admitted into universal use ; that which, to a demonstration, can be proved of the greatest bene- fit to the human race, is, when used, employed with fear and trembling, and seldom before at least a century or two elapse, so universally, or to such extent, as alone can insure all the utility of which it is capable. In that part of my practice, in particular where the cantharides requires to be employed, it were un- reasonable in me, therefore, not to expect the most determined opposition I am well aware that party spirit is exerted exactly in proportion to the effect of any newly proposed remedy in cure of disease ; and the proposer, together with the remedy, without giving either the opinions of the one, or the powers of the other, a fair trial, are often nearly overpower- ed by that concentrated mass of stupidity and in- fluence, through which the light of science can never penetrate. Their contracted views are cal- culated solely for the comfort and happiness of themselves, not, except in mere form, for the allevia- tion of that mass of human misery which, while it perpetually surrounds us, calls aloud for our inter- ference and relief. Since my publication on the internal use of can- tharides appeared, I have, independently of these cir- cumstances, had numerous opportunities, not only of confirming the doctrines there advanced, but of ex- tending my views on that subject to a much great- er extent than I at that time ever expected. My i 3 134 experience, on that subject, is now not only general, but, on the principles 1 th m hastily delivered, uni- formly successful ; and the numerous favourable communications, which I am daily in the habit of receiving, from every part of the country, convince me, that in a much shorter time than important im- provements in the practical part of our art, com- i) only meet with public sanction, this practice will, when under proper regulations, at once become still more general, and more extensively successful. 1 know that objections, from want of success, have been started to the treatment of several dis- eases by the cantharides. Such objections I was prepared to hear, whenever I should make known the success of my practice with that substance. To those, however, who without prejudice, or a wish to condemn, give the cantharides a fair trial, in such complaints as, from what I shall state, may indicate its use ; and who really have been unsuc- cessful, I have only to observe, that I can easily ac- count for the failure x>f many medical practitioners in the treatment of diseases by this substance. It was not, till after many years experience, and the closest attention I could bestow to its operation, that I became decide dly successful in the removal of complaints with that medicine, and even then failed in the removal of some cases, which, with still greater experience in the use of it, I have since completely effected It will undoubtedly be with those practitioners, as it was with myself ; but, by cautiously persevering in its use, and carefully watching its o- peration, they will be sensible of its importance. With regard to the cure of venereal, as well, indeed, as other complaints of the generative system of both sexes, no extent of reading, even the best books on these subjects, can, unless by accident, or in the very mildest form of them, enable us to do justice to our patient. Thus taught, the greatest success we can expect, is by some lucky accidental application ; 135 while the chances of error are innumerable. It is alone to experience, and scientific discrimination, that we are to trust for either safety or success in their entire removal. These diseases, in their va- rious stages, assume different forms, each of which requires a plan of treatment peculiar to itself. Al- though many of these changes may be described in books with tolerable accuracy, others can be best understood by the actual observation of one who is in the daily habit of suiting his practice to these changes, as they occur, and not regulating his pro- ceedings entirely by stubborn rules, or by the book he has been last reading. Yet no other diseases, to which the human frame is liable, are treated more by stubborn, general, and hackneyed rules, than those of the generative sys- tem ; and, excepting in their very mildest form, none seem to require nicer discrimination, attention, and alterations, in the plans of treatment, suited to the difference of constitution, and of the numerous appearances these diseases frequently assume. This generalizing plan, or total neglect, sometimes on the part of the patient, sometimes on the part of the physician, and not unfrequently on the part of both, or even injudicious treatment, which must solely be owing to the medical attendant, has often reduced a once healthy and robust consitution to the greatest possible degree of lingering misery. I have always been of opinion, that much, even of reasoning and philosophizing, has been ingeni- ously employed by authors, respecting many points relating to these diseases, from which it is impossi- ble, for either themselves or others, to draw one doctrine usefully practical. These reveries, T would call many of them, consequently become ex- tremely embarrassing and perplexing to the student or the young practitioner, and can be of no service to him of greater experience, it would render the subject at once more simple and more extensively I 4 136 beneficial, were such authors to recollect, that specu- lations are only useful in proportion as they can be more or less advantageously applied in unravelling mystery, or in curing disease; and that, in propor- tion as they deviate from this, they become either useless or hurtful in their application. Authors, too, in these speculations, often begin their researches, and make experiments rather for the purpose of forcing these researches and experiments to yield to some preconceived notion, than tobe guided and instructed by their result. Thus, determined to prove a point, they at length work themselves into an actual belief of its correctness, and no future re- monstrance, reason or experience, will ever con- vince them of the reverse ; not that they conceive themselves entertaining a wrong opinion, and pro- pagating perhaps hurtful doctrines, but that they have, by habit, brought themselves into a most re- ligious belief of its correctness, and even of the ex- tensive utility that must result from its application. In the works of many authors on this subject, 1 am sorry to find these observations too appli- cable, and that vague and illusory theory, rather than observation, has too often been the sole source from which they have derived their practical know- ledge. Those who have attended to the various changes and appearances which take place, in per- haps every case of these complaints, being aware of the impossibility of laying down general rules appli- cable to all cases, must often have been astonished, as well as mortified, to find descriptions of their va- rious stages, method of cure. &c. worked up with all the precision of a rule in arithmetic, ora mathe- matical problem. That there are a few general rules in their treatment, 1 admit ; but, from them, without attentive observation, particular rules can never be deduced ; and the authors, as well as practi- tioners, who are in the habit of writing about, or at- tempting to cure such complaints on other principles, 137 may assure themselves, that their success will bear no proportion to their disappointments. It would be well that such speculative practi- tioners would, in preference to their present plans, adopt the sound and solid practical reasoning of some of their ancestors. Although they had many faults, yet these in general consisted rather in a want of real knowledge, than in attempts to twist obvious facts to suit a particular theory ; but they had no wish to appear conspicuous, except in their suc- cessful treatment of disease. I say it were well that we would again return to that simple path ; then, considering the many facts which we, from altera- tions in the state of society, possess beyond what was knowrn in former times, we might render the mode of cure of such complaints, not, as is too of- ten the case, a jargon of inconsistent nonsense, but a system of well digested and well arranged doc- trines, demonstratively successful in their applica- tion. While some, I may remark, are affected with ve- nereal complaints, for instance, more frequently, as w r eli as more severely, than others, where no visible cause seems to exist giving rise to such peculia- rity ; we find also, that some are more liable to be affected with one form of the disease than with ano- ther. I may even observe, that I have known ma- ny gentlemen, who, although frequently exposed to the chances of such diseases, ha e escaped for ma- ny years without the slightest infection of any kind; while others have scarcely ever committed a sin- gle act of indiscretion without suffering severely. In the cure of these affection®, too, a certain degree of peculiarity exists in perhaps almost every one ; but in some so conspicuously, thai the very nicest management is necessary, both in selecting and employing such remedies as will most certainly re- move the infection. I know, that inattention to 138 these points has often caused much unnecessary- distress. There are also peculiarities of constitution, in which, though no visible cause can be assigned for it, there is the very greatest difficulty in curing such complaints, even independently of the most unremitting attention. I have known various in- stances of this kind. In such persons, if affected with gonorrhoea, gleet was almost an inevitable consequence ; if with lues venerea, buboes were al- most an invariable and immediate consequence, which no degree of attention seemed capable of pre* venting from proceeding to suppuration. In such habits, too, I think I have remarked, that secondary symptoms were much oftener to be met with, than in those in whom these complaints were removeable in the common easy way. I have in other places, had occasion to remark, that in scrofulous habits, in particular, diseases of every description seem more difficult of cure, than in those in whom none of the symptoms of that disease can be traced. In the venereal disease, in whatever form it may present itself, the correctness of this remark must have appeared to all who are extensively employed in this line of business ; and it must often, as with myself, have baffled all their exertions, at least for weeks or even months. Moreover, were many venereal complaints not great- ly altered in their severity, by the particular state of the constitution at the time, their cure would even in all habits, be much easier than it is, and would thereby render the application of general and inva- riable rules for their removal less objectionable ; but this, all practical physicians, who attend to their profession, know is not the case. Although, therefore, general rules are most commonly applied, and sometimes with success, they ought only to be used under the observation of one who can, it necessa- ry, vary the treatment, as circumstances may require. 13 Q In the cure of these complaints, I have, as form- erly stated, no purpose to effect by adhering to any particular hypothesis or theory. I endeavour to re- ly on observation, experience, and reason ; and, where these individually, or in combination, point out any doctrine which may, in a practical point of view, lead to a more successful mode of treating them, than I had hitherto been in the habit of employing, I ne- ver hesitate to lay aside that which greater and more extensive opportunities of observation and practice, either by myself or others, may convince me has been defective. I have always been of opi- nion, therefore, that it is chiefly a blind reliance on, and a determined adherence to, early acquired ha- bits and opinions, that has tended greatly to retard the improvement of every department of the me- dical profession. In proportion, then, as we became acquainted with the real nature of diseases in general, and con- sequently advance in our knowledge respecting the most judicious and best methods of curing them, we soon perceive the necessity of often applying our remedies more to the existing circumstances of the different stages of the complaint, than by adopting any general rule of practice. Treating the disease throughout, for a certain number of days, upon rvne formal principle, and a certain num- ber on another, which, although perhaps useful at one period of the disease, may he not only ineffi- cacious, but even hurtful at another, must at cnce appear improper. Yet the same mechanical plan as just noticed, is too generally persevered in, from the very first appearance of the symptoms, till they en- tirely either accidentally disappear, or, as in gonor- rhoea, till they terminate in gleet or in lues venerea, in the most alarming state of confirmed pox. By adopting, however a greater share of scienti- fic discrimination, we not only free our patient from 140 much unnecessary suffering, but' we are also en- abled to reflect on our own propriety of practice, and on the right discharge of our duty, with some degree of comfort, which, otherwise influenced, we have no claim to. What merit can a medical man claim to himself, when, on stalking up to his patient, and finding him affected with chancre or with gonorrhoea, for in- stance, he at once, in the most general way, pre- scribes mercury, or injections ; and that without putting himself to the least trouble on the occasion, to know the particular circumstances respecting the patient’s general health, mode of living, &c or even the state of the existing symptoms ; according to which examination alone every rational physician will conduct himself : Every one, although pos- sessed of no knowledge of medicine, knows that in- jections often remove gonorrhoea, and mercury chancres ; the use therefore of a medical man, is not to assure them of these facts, but to point out the time, and under what circumstances they may or they may not be used. 141 CHAP. I. TREATMENT OF DISEASED URINARY ORGANS. Of Suppression , Retention , and Incontinence of Urine. While the secreting vessels in the kidneys conti- nue their healthy action, these organs, in conformity with all other operations of the animal fabric, per- form their proper and healthy functions. But when, from malconformation, external injury, or occasion- al disease, these functions are less or more deranged, the secretion of urine become partially, if not com- pletely altered, and sometimes ceases entirely. When these occurrences arise from malconfor- mation preventing the secretion of urine, the cure is not to be expected either from internal medi- cines or surgical operations. When also the dis- ease exists in consequence of external injury, caus- ing a partial or a complete derangement in the functions of the kidneys, or perhaps extensive ul- ceration of these organs, our chances of cure must greatly depend on the extent of such derangement. Our first object, under these circumstances, is to remove the exciting cause, and our other means of relief must be indicated by the existing circum- stances of the case, when this has been affected. As suppression, retention, and incontinence of urine, may all arise from, or exist, either in conse- quence of an inflammatory state of the system, or in the directly contrary state, — that of debility, our 142 first object, previous to our employment of any other mode of treatment, ought to be, to ascertain to which of these states the system inclines, and how far these diseases depend upon them. These points may, in general, be easily ascertained, by due attention paid to the appearance of the general habit, as well as to the state of the pulse, &c. This being established, the plan of cure, so far as the disease depends on one or other of these states, is at once pointed out. In retention of urine from inflammation of the neck of the bladder, general blood-letting, if other cir- cumstances do not forbid such practice, is probably the best means of relieving it ; but if the patient be weakly, leeches may be used, and when the symp- toms have abated, a blister applied over the pubes will greatly assist in completing the cure. The warm bath, or gently sudorific medicines, will serve as our next order of remedies, with opiate glysters, frequently repeated. And on the pa- tient falling asleep, I have frequently found, that he discharged urine freely. I should therefore re- commend the free use of opiates, to procure at least, 6 or 8 hours sleep in the 24, and its constipating effects may be removed, by mild cathartic medi- cines. The different states of the weather has a very great effect in rendering this complaint mild or severe. Patients, therefore, thus affected, ought to have the temperature of their chambers rather warm than otherwise, and as little subject to change as possible. If these means prove ineffectual, an artificial opening must be made into the bladder for the evacation of the urine. The puncture ought either to be made above the pubes, or through the rectum. I would prefer performing the operation in the last of these as, should the patient be corpu- lent, we have sometimes to cut a great depth before we can reach the bladder. When retention, however, arises from an imper- vious obstruction in the urethra, and if the bladder 143 is too much distended to admit of delay, we must at once make an opening in the manner just stated, and discharge it. After this, we must instantly re- move the obstructing cause. Perhaps, in this in- stance, from the necessity of dispatch, the instant removal of it by incision is preferable to any other method. A bougie being introduced into the ure- thra as far up as the stricture, we should make a small incision along the course of the urethra, and then, by cutting even upon the point of the bougie, make an opening for it; after having secured the opening along the urethra, we must adopt such measures as will most readily heal the external in- cision. The very mildest cathartics may occasionally be given, but none that will irritate the bladder, which is the case with a- great variety of drastic purgatives. In slight debility of the fibres of the bladder, causing retention of urine, we, for the most part, may give considerable relief, after the catheter has been introduced into the bladder, by applying pres- sure or friction with the hand, or with a common flesh brush, so as to excite and occasion contraction of that viscus ; for without its contraction no urine will flow. At other times, however, the debility of that organ is so great, as to require, in combina- tion with the above, which is but of temporary be- nefit, much more active means in order to obtain lasting relief. In such a state of disease, nothing tends so much to remove the torpidity of the bladder, as the ju- dicious employment of tonic remedies, with, in al- most every case, the application of a blister over the sacrum ; and the remedy which I have found most useful, is the tincture of cantharides, in doses suf- ficiently great to affect the urinary passages. This state of action in the parts must be kept up for a length of time proportioned to the extent and se- 144 verity of the disease ; the removal of which may be known by the bladder resuming its natural func- tions, even after we have found it proper to give over the use of every kind of medicine. When the catheter, which in almost every case ought to be a large size, is to be introduced, the patient ought to be laid on his back, with his thighs gently opened, and his legs hanging over the side of the bed. The penis is grasped in the left hand of the operator, who rests on his right knee by the left side of the patient. The instrument is to be well oiled, and introduced with the concave side toward the abdomen. If there be no morbid ob- structions in the urethra, it always passes freely forward till it arrives at the membranous portion of that canal, when, as the urethra here takes a slight turn, which often obstructs the catheter, it should be slightly withdrawn, the handle of it somewhat depressed, and then another attempt to push it for- ward generally succeeds. It is next apt to be ob- structed by the prostate gland ; but the same motion as above directed being made, the instrument slips into the bladder. When the spasmodic action of the parts exist, the directions to be given under the head of spas- modic stricture, must be applied here. Unless in this disease, the most active means are immediately used, sloughing of the parts with ex- travasation of urine, and even mortification ; will very rapidly ensue. Bleeding, blistering, and the free use of mild saline, purgatives, must therefore instantly be had recourse to, with the most rigid abstinence from every kind of exercise, stimulating or inflammatory liquors, or medicines. When these violent states of action of the system exist, which, if not removed by other means, re- quire the bladder to be punctured, we ought to be very brief in our proceedings, as the worst conse- 145 quences may ensue from the delay even of an hour. If, therefore, on the appearance of this state, our remedies, which must be vigorously administered, do not effect our purpose as soon as their action should affect the general system, we ought instant- ly to have recourse to puncturing the bladder. In performing this operation above the pubes, a perpendicular incision is to be made through the integuments of the abdomen, at least two inches in length, immediately above the pubes. The part of the bladder, uncovered by the peritoneum, will then appear, into which a curved trocar is to be introduced, and when the stilet is withdrawn, the urine will flow* In performing this operation by the rectum, we must, in order to avoid wounding the vesiculae se- minales, introduce the finger its whole length into that canal ; a trocar having previously been laid on the forepart of the finger. The puncture must be made into the anterior part of the intestine, which is easily done, the parts being in general so thin, that even fluctuation of urine may be felt before in- troducing the trocar into the bladder. But, if we are not well acquainted with the structure of the parts, both in a state of health and disease, their natural situation may be greatly altered, and conse- quently may deceive us. This may occur from tu- mors, thickening of the parts, or from diseased prostate gland* Previous, therefore, to our per- forming this operation, we ought particularly to as- certain the exact state of the parts. When the bladder has burst, remedies are in- effectual. Even a rupture of the inner membrane* is perhaps bey ond the power of surgery or medicine, but its effects are not at least so immediaiely dan- gerous as the other. The states of that organ, which may be remedied by art, are those degrees of distension which it suffers, rendering it unfit to per- K 146 form its healthy functions. If retention arises from this state, the urine must be drawn off by a catheter or hollow bougie; and if the difficulty to introduce the bougie be greater than usual, we may allow the hollow bougie to remain in the bladder. When, from incontinence of urine, we have as- certained the nature of the disease, the state itself indicates the nature of the remedies which will re- move it If it arise from one or more of the parts immediately connected with the disease, having as- sumed anew action, such as complaint of the prostate gland, obstructions in the urethra, stone in the bladder, or other affections of the general system, our attention must first be directed to the removal of them. If, however, it be alone caused by debility of the bladder, &c., stimulating medicines used internally, and applied externally, as cold bathing, stimulting liniaments, blistering the loins ; the internal use of bark, tincture of cantharides, &c., will generally effect a cure. Respecting paralysis of the urethra, or rather of the sphincter vesicae, Mr Hunter observes, in page l66 of his book on venereal complaints, that “ a man came into St George’s Hospital with this complaint. I ordered him the before mentioned medicine, (cantharides) and it had such an effect as to bring on the contrary disease, or a spasmo- dic affection of the urethra, so that he could not make water when he had an inclination ; but an injection of opium removed the complaint, and he was then well-” When incontinence of urine exists in con- sequence of irreparable injury done to the parts in performing surgical operations, such as litho- tomy, &c , we must learn to accommodate our pa- tient to his inconvenient situation. In surgical books, we shall find delineations of such instru- ments as are useful on these occasions, and these must too frequently be used during life. 14 / CHAP II. TREATMENT OP MALE ORGANS. Of Seminal Emission. It is absolutely necessary to a scientifice treat- ment of every complaint, first to ascertain its causes* its effects on the parts immediately concerned, and also those which it produces on the general system. The difficulty of being able to ascertain these, is sometimes great ; but it is possible to do so, in per- haps every instance, and then their removal becomes comparatively an easy task. In seminal emission, this has been much overlooked, and consequently its cure has been deemed impossible. But if we had considered the great debility induced on the parts, by the overaction which frequently was artificially induced before the complaint was constituted, and then the consequent debility of the whole system which ensued, we only require to know what re- medy will restore them to their healthy action. The cantharides, in a very extensive range of prac- tice, have never with me failed in the removal even of the worst cases ; and I, therefore, with the ut- most confidence, recommend it to the attention of others. If this complaint arises, which in almost every case it does, from excess of venery, or from self pol- lution, the first and most important advice the pa- tient can receive, is to refrain from these habits. K 3 148 For, while these are perserved in, no method of cure can W effectual. In other respects, the medical practitioner’s ad- vice must, no doubt, be dictated by the state of his patient. No disease, however, has been more un- derstood, or worse treated in general, than this. Medical men, influenced in their conduct by the notion, that the venereal appetite a rises from a vi- gorous, and, as it were, an inflammatory state of the system, and that, whatever excites or promotes its activity, aggravates these desires, enjoin abstinence from animal food, from ardent spirits, from every thing, in short, which they suppose can heat the body, or excite the circulating powers. This reasoning is certainly just, when applied to individuals in the flower of health, and vigour of youth ; but it is very erroneous when applied to those whose bodies are exhausted, enfeebled, ill- nourished. It is here a disease of habit and de- praved mind* not excited by repletion and supera- bundant vigour. Here the almost exhausted pow- ers are to be invigorated, debility to be obviated* the body to be nourished, the mind to be rendered cheerful. Are these objects to be accomplished by abstinence from every thing which contains the principles of activity, or of supply for the animal machine ? It was impossible that such a practice could ever be successful ; and hence it is, that the triumph of empiricism over regular practice has never been so great as in this complaint ; because the empirical medicines contain active substances, which patients find useful to them when the other means have failed, or are even hurtful. 1 venture to affirm, that the means which are most beneficial in such cases, are nourishing diet, moderate use of wine, animal jellies, certain kinds of bodily ex- erei'C, increased a ording to the return of the pa- tient’s strength : opium, musk, assaloeiida, camphor. 149 occasionally, to procure sleep, aleviate spasmodic symptoms, and calm the apprehensions of the mind, together with such means as shall be best suited to keep the bowels regular, and restore soundness to the organs of urine and generation. Repeated erection in the night, and copious dis- charge of semen, in consequence of dreams, though the individual is not addicted to any blameable practices, is not an uncommon disease ; and to this form of complaint, the reasoning which was erron- eous, and led to hurtful practices in the former, will apply with propriety. Spare diet, cold bathing, frequent ablution of the parts in cold water, sleeping in a cool chamber with few bed cloaths, and not too foft a bed, some busi- ness that will arrest the attention, &c. 3 are here to be advised. From a long continuance of that state of the parts which causes seminal emission, the internal lining of the urethra becomes so completely diseas- ed as to the prevent its ever again resuming its healthy actions. While in this state, it must act as a foreign substance applied to the parts, and greatly increase the disease I have always observ- ed that, in this state of the parts, such cases of se- minal emission as have come under my observation, have been longer of being removed, than under any other circumstances. Months have often elapsed and, independently of the very greatest attention on my part, these symptoms have not in the least degree relaxed, but, on a quantity seemingly of membranous substance being voided along with the urine, the severity of the symptoms gradually abat- ed, and the parts completely recovered, The severity of a complaint is but a relative, and at best a vague term ; hence authors, having no- thing to compare their meaning by, when they em- ployed such a phrase, were very apt to consider it severe or otherwise, according only to their particu- K 3 150 Jar success, not according to the extent of the com- pl dnt itself Thus we have seminal emissions, said to be of the very worst kind, cured by medicines extremely tiifhng and inefficacious. It is scarcely possible thai the rehters of such cases could state what did not really happen, but the indefinite man- ner of considering such complaints must have led to the mistake. In seminal emission or impotence, then, the most erroneous practice has always been followed, because, as formerly stated, medical men really did not seem to understand the nature of the disease, and their practical doctrines were consequently fraught with the grossest error. They found it necessary to say something on the subject, and, as in almost all other guessed works, they stumbled on error : yet. Strange to tell, they gave detailed cases of their success, with as great a degr e of gravity as if they had actually been successful. The common, and indeed all remedies then re- commended even by the the most respectable wri- ters, f rom their thus evidently having entertained the most erroneous notions respecting the nature of the disease, were at least ineffectual. Mr Hunter’s sole dependence was from the effect of opium, bark, valerian, mu*k, camphor, and the cold, and some- times warm bath, individually used as he deemed it proper. In the very slightest cases, these substan- ces might probably prove of some service, but, in more severe affections of this sort, they might be used in any quantity, and for any length of time, till they destroyed the digestive organs, but they never could relieve the disease. On account of the disordered state of the diges- tive organs which almost always accompanies this disease, it is necessary that the food and drink of the patient should be such as to contain much nouiishment in small volume, and such as are easily digested, baited or high seasoned food do not come 151 under this description, and are therefore, in an es- pecial manner to be avoided. Indeed every sort of food, particularly animal food, must be avoided at supper, before going to bed. While there are perhaps no complaints to which the human body is liable, which are, in certain states, so tedious of cure, it is a fortunate circum- stance, that the principal medicine by which such diseases are removed, can, under proper regulations, be taken to any extent, or for any length of time, and even then with the most beneficial effects. No instance, indeed, of such complaints, uncom- bined with any other, has yet come under my observation, which has not, by patient persevere ance, been completely and permanently remov- ed. In this particular point, the cantharides dif- fer from every other medicine with which I am acquainted. All other substances lose their effects by use, and, if we expect good effects to arise from them, must be increased in proportion to the time they are used, while they at the same time assist, in a greater or less degree, in injuring the consti- tution of the person who employs them. Canthari- des, on the contrary, improve every faculty, both of body and mind, the longer we employ them, while, instead of increasing their doses, we are ac- tually obliged to decrease them, and that often from the largest to the very smallest quantity that can be used. As, from the alterations in the functions of the parts, under the use of the cantharides, from dis- eased to healthy action, the emissions may even be reproduced by the stimulating effect of that medicine, we have reason rather to be pleased than otherwise, at such an event arising from such a cause. I have several times in practice met with this circumstance, and have uniformly found, that then the opportuni- ty ot abandoning the medicine was at no great dis- tance. When great irritation (for it is in this stage k 4 152 only, that irritation is produced by the cantharides) occurs almost every time the medicine affects the urinary organs, and that probably accompanied by an emission, then we must begin rapidly to dimin- ish the doses. After this, it is not always ne- cessary to have recourse to the medicine again ; but, if it should be so, the patient’s own feelings of debility must convince us of the propriety of such a measure. At this period, if such steps should be necessary, that propensity to gloominess of mind, so commonly present in such complaints, and so apt to overpower the patient, is likely to return. This we ought, if possible, to prevent, as then it is only necessary to take the medicine one week, and to omit it the following one, during a few months, in order to insure him of the most perfect recovery. Even were it found necessary to use the medicine during the remainder of the patient’s life, a circumstance which I never yet met with, it can produce no bad effects, and would certainly be much less troublesome than the presence of the complaint for the removal of which it was em- ployed. CASE. A Gentleman, aged 40, stout, and of a dark complexion, several years ago contracted a gonor- rhoea, which was removed by injections, contain- ing acet. plumbi in solution. Soon after the re- moval of the discharge, he felt great debility of the parts of generation, and very seldom had any in- clination to the fair sex. It was not till after two years and a half, that he began to recover his wont- ed vigour when he again had the misfortune to con- tract a gonorrhoea ; this too was cured by injections, containing acet. plumbi. Immediately after the re- moval of the dis harge, all the symptoms of his former weakness affected him, and he repeatedly 153 observed great quantities of scaly membranous sub- stances floating in his urine, unaccompanied, how- ever, by any gleety discharge. When he informed me of the above circumstances, in addition to his other complaints he mentioned, that for two months previous he had frequently, while in bed, been affected with involuntary emis- sions of semen. After these occurrences, the stream of his urine was undiminished in size ; and I now prescribed for him, tinct. cantharid. 3fs, aq, fount. 3vi, a table spoonful to be taken four times a day. Two days after, he observed a drop of blood at the external orifice of the urethra, but experienced no pain or uneasiness from taking the medicine, and in two days more, the membranous substances formerly mentioned were not so plentiful as at first. 1 therefore desired him to continue the can- tharides. For two months he persevered in the use of that medicine, in sufficient doses to produce slight dif- ficulty in voiding urine. During this time, the se- minal emissions gradually became less frequent, and the scaly substances, which he voided with his urine, changed from white to a yellowish colour, but did not diminish in quantity. As I was obliged to be in London about two months after, I left instructions with my patient, on whose accuracy I could depend, to continue the tincture in doses similar to what he had been accustomed to, and to use the cold bath thrice a week. On my return, about six weeks alter, he inform- ed me, that he had continued the catnharides regu- larly, till within the last ten days; and as he had, previously to that period, experienced the most be- neficial changes in his health, I declined giving him more of it. The scaly substances had now completely disappeared, and for the last six weeks, he had only two seminal emissions. I, however, 154 desired him to continue sea-bathing while the wea- ther was favourable In September i80C), he had experienced no re- turn of his complaints, and his general health was mcuh better than it had been from the commence- ment. CASE On the 12th of January, a gentlemen aged 28, complained of great general debility, with acute pains in his loins, occasionally darting down his thighs. For fourteen years he had been subject to wet dreams, from improper practices, sometimes re- turning almost every night. He never had, how- ever, any gleet discharge or venereal complaint ; never having had a connection with any female. His attempts of this kind were attended with such immediate embarassments , as might be expected, producing the usual despondency of mind. These emissions usually occurred during the night, while he was in bed, and were followed by a disagreeable burning heat all over the body, with great anxiety and heaviness, but a complete inabi- lity to sleep during the remainder of the night. He, however, passed his urine in a full stream. I ordered him to substitute for the soft bed, to which he had been accustomed, a hard matrass, to use few bed cloathes, and to sleep in a w'ell venti- lated bed chamber. I likewise prescribed nourish- ing diet, with two or three glasses of wine after dinner, and tinct. cantharid. aq. font, of each Two tea-spoonfuls to be taken thrice a day in a glass of water. On the 13th, he was affected with considerable pain and difficulty in voiding urine. I therefore ordered the cantharides to be taken in smaller doses. On the i6th, he had taken the cantharides in 155 sufficient doses to keep up a slight degree of unea- siness in the urethra, but had nevertheless an emis- sion last night while in bed. I ordered the can- tharides still to be continued. On the '20th, he had another emission. These, however, were less frequent than before the use of the cantharides. On the 2 1st, he had another emission, after which, however, the burning heat, &c. over his body did not trouble him. The cantharides were therefore still continued. On the t)th of February, he continued to take the cantharides in sufficient doses to keep the parts uneasy, and till the morning of this day, had no emission since the 22d ult., and even it was not at- tended by the disagreeable symptoms above describ- ed. The cantharides, therefore, were still conti- nued. On the 7th> he had another emission. And since he began to use the cantharides, he had ob- served, that it was not till two or three days af- ter an emission, that the medicine again produced its usuaL effects on the urinary organs. The emis- sions, however, were now of rare occurrence, and he felt stronger and in better health than he had done for several years past. The pain in his back had greatly abated. I still ordered the cantharides to be continued On the 1st April, the emissions since last report, had occured about once a week, and he thought they were now most frequent when he happened to take an over dose of the cantharides 1, however, desired him to use the cold bath twice a week, aad to continue the cantharides. On the 26 th, the emission also continued once a week, but were unattended by trie disagreeable sensations which formerly accompanied them. Although his general health was very comsiderably improved, he began now, from the length of time 156 which had elapsed since he expected relief from the cantharides, to be anxious about his complaints, and almost completely to despair of ever being cured of them. I ordered the cantharides still to be continued. On the 8th of May, the emissions had, for ten days past, been more frequent than usual. I began to suspect that he occasionally recurred to the origin- al cause of his disease, and hinted to him, that with such habits he could never expect to be complete- ly cured. He was rather offended at my suspicions, and positively assured me, that in those suspicions I did not do him justice. I thought it right, however, to impress his mind very strongly on the occasion. I did not see my patient till the first of June, when he again assured me that my suspicions were erroneous; that he was now much better, havmg had no return for a fortnight past. This agreeable change, however, I attributed to my remonstrance, and ordered the cantharides, &c. to be still conti- nued. This patient now went to sea bathing quarters, and I did not see him again for nearly three months, when he told me, that his complaints, during that period, had become worse ; but he confessed, that he had used the cantharides, &c. rather irregularly for sometime past. I then represented to him the danger attending the long continuance of such complaints, which alarmed him much, and he pro- mised to be very attentive in future ; and, by the closest attention to the rules laid down to him, he informed me, about the beginning of Novem- ber, that his former complaint had returned only about once a month. B) the end of the year, he had completely recovered, and had even become re- markably stout. 357 CASE January 4th, a gentleman, aged 22, stout made, but considerably emaciated, was, about two years ago, (probably from the same cause as in the last case), suddenly affected with the same in- convenience, sometimes thrice in the course of one night, attended with an uncommon desire to vene- ry. Since the commencement of these emissions, he had been affected with gonorrhoea, which was soon cured by the use of injections. This original complaint, however, did not seem in the least af- fected by the gonorrhoea, as it continued exactly in the same degree after that disease had left him. Palpitation of the heart, and almost constant ringing in the ears, had of late troubled him very much. He suffered no pain; his mind, however, was in the greatest state of despondence, and his life was actually become a burden to him. He was at last distressed by the most dreadful dreams, which rendered him melancholy for several days after. They were principally respecting the death of some of his nearest relations ; and although he was not at all superstitious, he could not prevent his mind being thus affected by them. What as- tonished him very much was, that he often dream- ed, that he himself was about to expire in the arms of his relations : and once or twice he actually thought he had quitted this life. He gradually be- came very stupid, and unable to apply his mind to any employment, but was quite sensible of his be- ing in that state, and for sometime past his feelings had become morbidly acute, which, if possible, aug- mented his affliction To these symptoms were added, about a year ago, general weakness, with most distressing pains in his back; and, for six months past, he had expe- rienced sudden giddiness, and a sort of faintness. 158 during which, objects of various colours seemed to float in the air before him ; and this was immedi- ately succeeded by perspiration all over his body. He was, about the time I saw him, frequently af- fected with cold sweats over his body, coldness in his feet and hands, with a great degree of coldness in his generative organs. For the last three months he had, almost every night, been troubled with very painful erections, but without his former desire for venery, which often kept him awake the whole night. He was now affected with a slight tickling cough, with pains in his breast ; but his expectora- tion w r as not very copious, though of a blackish colour. Every attempt at connection had, for se- veral months, been instantly attended with an emis- sion, and he had uniformly observed, that if at any time the emission did not occur for a few days, that next time they appeared, the semen was great- ly encreased in quantity to what it was on other occasions, and continued to be so for two or three days. A celebrated surgeon, to whom he applied, had recommended strong doses of physic, and daily co- pulation, which he assured the patient, would les- sen the emissions ! I prescribed tinct. canth. 3 j, aq. font. B vii, a table spoonful to be taken thrice a day, and the doses to be gradually encreased. On the 5th, he experienced great pain in void- ing urine, which continued to encrease in severity during the day. He therefore left off the medfcine, and before night this symptom had abated. On the 6 th, I desired him to take the canthari- des as recommended on the 4th. On the 9 th, he had no return of the pain, al- though he had now taken the cantharides in in- creased doses. Since he began the use of this me- dicine, he slept much better than formerly, and had almost constantly felt a strange sort of prickling 1 59 ling sensation all over his body. I have ordered the cantharides to be continued. On the 14th, he had suffered very little pain from the last report, and ever since he had began the use of that medicine, he had no emissions. He, however, almost every night, felt as if the emission was just coming on, though it did not. I therefore ordered the cantharides still to be conti- nued, with half a pint of wine per diem, and the li- beral use of porter. On the 1 Oth he complained, that general debi- lity had again recurred, but he had no return of the emissions. I therefore ordered the cantharides, to be continued still. On the 18th, he accounted for the above symp- toms, from his having exposed himself to damp- ness for a considerable number of hours. The can- tharides, &c were still continued. On the 23d, he had an emission while in bed, but that had not in the least distressed or even roused him from his sleep, as he did not know of it till morning. His general health was not much improved. The cantharides were still continued. On the 1st, of February, he had no return of the emission, and from the changes that had taken place in his health, he was in very high spirits. He was now stout, and able to walk a number of miles without being fatigued, which formerly he could not do. The cantharides were still conti- nued.. On the 6th he had, for two days, suffered very considerable pain from the cantharides, and during the previous night, while in bed, he had t wo emis- sions, which depressed his spirits considerably ; and on the night of the 7th he had another. On the 8th, when he informed me of the above occurrences, he likewise mentioned, tnat the giddi- ness and dimness of sight had returned ; the pain from the cantharides had however abated, and I therefore desired him to encrease the doses. On the 15 th, for several hours, the pain from the cantharides had been very severe, and during it he an emission. He uniformly remarked, that he had had, in rapid succession, one or more emissions when the cantharides affected him severely. These emis- sions, however, were not now accompanied by these troublesome sensations which formerly attended them ; and his appearance was much improved, ha- ving lately become much stouter than usual. Nor was he so apprehensive as formerly, and the gene- ral gloomy state of his mind was entirely removed. The cantharides were still continued. On the 11th of March, he had, since last report, only one emission, which did not distress him in the slightest degree. He had now become very stout, and was, in every respect, in a state of good health. I however desired him to continue the cantharides in moderate doses, and to use the cold sea-bathing during the summer season. In September I 8 O 9 , he continued entirely free from his complaints. CASE A gentleman, aged 20, apparently stout, was about £) years ago, while at school, initiated in bane- ful practices. It was not till after three years con- tinuance in these habits, that he felt the least in- convenience arising from them. Then, however, he was suddenly affected with frequent emissions while in bed ; but as they proved only troublesome for the moment, he was not in the least degree intimidated by them, and for a year after, he conti- nued his habits more frequently than ever. About two years ago, these involuntary emissions became more frequent, troubling him four and often six times every week. These were now followed by m cold shiverings, which lasted for an hour or two each time, with complete inability to sleep during the remainder of the night. He was now also af- fected with frequent cold perspiration all over his his body, with coldness of his extremities, with shrinking of his generative organs, and great pain of his stomach ; sometimes with a voracious appetite for food, but more frequently a disgust to all vic- tuals for several days. On such occasions, if he swallowed any thing but liquids, the sensations he felt in his stomach were not actually painful, but indescribably irksome. From the difficulty, too, which he felt in being obliged to perform the act of respiration, almost entirely by his voluntary pow- ers, he believed he should die suddenly while in bed. About that time, he felt an irregular swelling in one of his testicles ; and he began, for the first time, to suspect the real cause of his complaint. To prevent his relations from becoming acquainted with it, he exerted his ingenuity to prevent them from applying for medical assistance. He at first thought, that, by abstaining from his former prac- tices, which he now resolved to do, he should reco- ver without being obliged to have recourse to any other expedient, but this would not do ; for now, in addition to his other distresses, his bowels be- came obstinately costive* and he could procure no evacuation, without the assistance of cathartic me- dicines. These, with the cold bath, and the inter- nal use of bark and wine, and occasionally mineral waters, were the only medicines he used, till he ap- plied to me. He assured me, that he had nothing to accuse himself of for about two years. His eyes, however, seemed dull, and he complained of partial blind- ness, particularly for an hour or two after he had an emission, which happened from four to six times every week. He had no gleety discharge, nor had h 162 lie ever in any form been affected with a venereal complaint. He complained of an almost constant dull pain in his back, and in his stomach, and an uneasy sensation in the left testicle, which he in- formed me had swelled considerably for two years. On examination, I found that this was a very con- siderable enlargement of the convolutions of the epididymis, and also of the spermatic chord; but as the pain from it was inconsiderable, it gave him no alarm. His bowels were still in a state of great torpidity, so that, without the exhibition of a ca- thartic, he was unable to procure an evacuation ; and if he omitted the liberal use of bark and wine, his food, for several hours after taking it, produced the most uneasy sensations in his stomach ; and, on such occasions, he had most excruciating pains in his head. On the 20th of December, I prescribed for him tinct. cantharid. sfs, aq. font, vii,- — a table-spoonful to be taken four times a day. On the 23d 1 repeated the mixture, and with it the following powder, as, after every dose of the cantharides, pain and uneasiness about his stomach became very troublesome, 1^. carb. ferri, Bi, zinzib. alb. Bi, cort. per. $i m. A tea spoonful to be taken thrice a day in a little water or wine. Before a week had elapsed, he felt slight diffi- culty in voiding urine, but the pain in his stomach was not nearly so troublesome as before the exhibi- tion of the powder. He remarked, that all tonics, particularly of the mineral kind, had uniformly agreed with his stomach, and he thought lie had derived partial relief from the internal use of such mineral waters as are to be found in the neighbour- hood of this city. Emissions, however, still continued as formerly. On account of the pain in his stomach, I desired him to take chamomile tea, . instead of common tea, for breakfast, and animal jellies instead of animal food, for dinner ; with occasionally a lax- ative pill, composed of equal parts of extract of hy« ociamus and aloes In this way he continued till the end of January, before he was sensible of any change in his complaints, and even then, there was only an abatement of those very distressing sensa- tions, which invariably had followed the emissions, but no alteration in the frequency of their returns* On the 1st of February, the pains in his stomach were, immediately after the use of the tincture, very troublesome. I therefore desired him to omit it en- tirely, and, in addition to the other articles of diet* to use nearly a pint of port wine per diem, and, in- stead of eating at the stated periods, to take a small quantity of animal jelly, or nourishing soups* every two hours ; but never to take either of them in Such quantity at once, as to satiate his appetite for food. On the 25th, having suffered ho pain in his sto- mach for about It) or 17 days, he recommenced the use of the tincture ih small doses, and his other articles of food &c. were continued as formerly, with the addition of the cold bath every morning. By the 12th of April, gradually augmenting the doses, he could take about three drachms per diem of the tincture, which did not occasion any pain in his stomach, but kept up a constant degree of irritation in the urinary organs. The emissions did not now occur oftener than once, sometimes twice a week ; and no disagreeable sensation was felt after them when they did occur. His bowels became much more regular than formerly, and he only required one of the laxative pills every two or three days, in- stead of one every day. On the 1 5th of May, he again felt severe pains in his stomach, immediately after taking a dose of the tincture, in consequence of which I desired him to diminish the doses ; but the pain being still produced, he was ordered to discontinue the use of the tincture entirely. I remonstrated with him on 12 the impropriety and even danger of indulging in former practices, but he assured me that he did not ; as his anxiety to be relieved of his complaints was very great. I attempted twice or thrice to re- commence the use of the tincture, but even the smallest doses produced pain in his stomach ; and he now observed, that almost immediately after taking a dose, he had an emission. On the 1st of June, I therefore omitted the tincture, and gave him a saturated solution of phosphorus in aether *, with directions to take two drops in a glass of water thrice a day. He once or twice added one drop to the dose more than he was desired to take; but from the disagreeable sensations which he felt in his head, immediately after taking it, he did not in future feel much inclined to deviate from the the rules laid down to him, but, with the greatest care and attention, continued to increase the doses till the 20th, when he told me that the emissions were now not oftener than once a week. I desired him to continue the solution, gradually increasing the dose. In October following, this gentleman had enjoy- ed much better health than he had done for about three years past ; his appetite for food was more regular, and the state of his bowels more natural ; his sleep was undisturbed by frightful dreams, and the emissions occurred only once a week, and were unattended by the sensations formerly so distressing to him. I desired him to continue the medicine a few weeks longer. On the 2d of June in the succeeding year, I was glad to be informed by my patient, that although the swelling in the spermatic chord still continued, * I have, for some years, been in the habit of prescribing this very active medicine in paralytic affections, and in certain diseases of debility, with very flattering promises of success. See the case near the end of this work. 165 yet his health was good, and he was capable of ex- ercising all his functions, and seldom had an emis- sion. In September I8O9, this patient continued in perfect health. CASE. A gentleman, aged 23, when about 12 years of age, fell prematurely into bad habits. About six months after the commencement of these prac- tices, he felt very disagreeable sensations about his generative organs^ This was not an acute pain, but a sensation, as it were, of something trickling about his perineum and testicles. Soon after this, he experienced great pains shooting along the in- side of the thighs, and from time to time, a sharp stinging pain darting along the penis. To these were added, incontinence of urine, which, as it was passing, and for a few minutes after, caused a burning sensation, with a sense of fullness about the glans penis. At this time, he had frequent cold shiverings, and great restlessness during the day, and inability to sleep during the night, in consequence of being troubled by the most fright- ful dreams, the recollection of which, even while he was awake, terrified him. In this situation he continued two years, when, in addition to the above complaints, he had frequent involuntary seminal emissions. An extensive ulcer, too, broke out on the penis, which was healed up in a few weeks by simple dressings. His urine at that time became very turbid and extremely foetid. The night dis- charges continued to increase in frequency, and about a year after their commencement, he was af- fected with severe pains in the back and stomach, which spread to the intestinal canal, and he became very costive. Laterly these sensations had affected every part of his body, rendering even the friction L 3 166 of his wearing apparel painful to him. The great debility he now laboured under, was indescribable, and the semen actually run from him on using the slightest motion. He was advised to use sea bath- ing, (a very common advice with medical men, when complaints are likely to baffle them), but from this he derived no benefit; even while making the exertion necessary in swimming, seminal emis- sions distressed him, and this was immediately fol- lowed by cold shiverings and most distressing debility. The glans penis was swelled to an enormous size, and the preputium was pushed behind it. This con- tinued several months, when the swelling began gra- dually to abate, but the prepuce never returned to its natural situation. This was soon succeeded by a continual perspiration all round the sacrum, and the parts immediately in its neighbourhood ; and soon afterwards, he experienced most excruciating pains in all the lumbar vertebrae, which were follow- ed by an evident distortion of these bones General emaciation, to a great degree, soon followed, and inflammation again affected the penis, but much more generally than on the former occasion. It however only continued a short time, when it dis- appeared spontaneously. An intolerably foetid dis- charge, of a yellowish colour, now proceeded from the corona giandis, and he applied to a surgeon, who told him that his disease was venereal, and prescribed for him a course of mercury. From this he derived no advantage, although he continued to use it several weeks. He was then informed by his medical attendant, that his complaint was gravel, and was advised to use sea bathing for its removal. His penis and testicles now shrunk very considerably, and were drawn up so close to the abdomen, as scarce- ly either to be seen or felt. Soon afterwards, how- ever, his testicles and scrotum swelled prodigiously, and ever since that trine, the convolutions of the 16/ epididyfnus have been enlarged, and distinctly felt through the scrotum. For several years past, most of the above com- plaints have been stationary. By degrees, however, his mind partook of the general disorder; he be- came very timorous, and the least alarm threw him into great agitation. He became extremely weak, and quite incapable of following any occupation : and night sweats, with difficulty of breathing, horse- ness, and cough, prevented him from sleeping even when he became drowsy. Great depression of spirits, with languor, dimness of sight, tingling in the ears, and continual horror of mind, had, for sev- eral years past been gradually added to his other complaints, which, when I first saw him, had ren- dered his life a great burthen to him, I prescribed for him twenty drops of the tincture of cantharides, to be taken in a glass of water, four times a day. He gradually increased the dose, and at the end of four weeks, he was taking half an ounce of the tincture daily, when it, for the first time, occassioned him considerable pain in passing water. Being three or four miles distant, I did not see him when this sensation was first produced, and continuing to take the medicine in the same quantity, the pain occasioned was of course very- severe, For two or three days, about that time, he passed water involuntarily, and an almost con- stant profuse perspiration pervaded his whole skim I desired him to give up the use of the medicine for a few clays, to apply warm clothes to the lower part of his belly, and to take a smart purgative. In a few days these uneasy symptoms disappeared, and I desired him to recommence the tincture in very small doses. With the usual cautions which I have elsewhere recommended, he continued to use the tincture, sometimes in larger, sometimes in smaller doses ; and in less than three mouths from the time he be- L 4 gan to use the medicine, he became much stronger, took his food better, and some of his numerous complaints had entirely disappeared. Even at this cold season of the year, (January,) I desired him to use the cold bath, which, in addition to the former prescriptions, he continued to do with the greatest advantage. I desired him likewise to take half a pint of wine every day, and to live on good nourishing diet. Under the properly regulated management of these prescriptions, he recovered from his complaints by slow degrees, and he was, in July following stout and active ; and, but for that general gloom which his former state of body seems to have entailed on him, he has no com- plaint. I have desired him to decrease the doses of the cantharides by slow degrees, and to con- tinue the cold sea-bathing for the remainder of the season. In October 180Q, although the spermatic chord of this patient still remained enlarged, and he had occasional emissions, yet even these were so rare as not to constitute disease. CASE An unmarried gentleman, aged 30, was addicted to private indiscretion at so very early a period, that from secretion of semen not subsequently taking place he could not procure an emission ; but being ignorant of the bad consequence of such practices, he continued this habit to excess for a considerable length of time. The first bad effects of these prac- tices, which he did not then attribute to that cause, was frequent giddiness, attended with a sensation as if the earth, as he expressed himself, was sink- ing under him. Still, however, he did not refrain from his bad habits, and of course these symptoms gained ground. To these symptoms were added others \ he became perpetually apprehensive and 369 alarmed, be knew not for what, on the most trifling occasions ; was almost constantly troubled with violent palpitation of his heart, with stinging or shooting pains across his chest, and on such oc- casions he experienced flushing of the face, and a most disagreeable heat all over his body, particu- larly in the palms of the hands, and soles of his feet. His testicles now hung lower than usual, par- ticularly the left, and the spermatic chord was some- what enlarged, and very painful. His mind now seemed to partake of the general disorder, he be- came awkward and stupid to a great degree ; all his mental faculties suffered considerably, especially his memory, which, unless on very particular sub- jects, and these of the very simplest nature, almost entirely left him He laboured under a continual ap- prehension, that at some period at no great distance, he would altogether lose his reason. What ren- dered his situation particularly distressing, was his being perfectly sensible of all his distresses, and of all his mental depravations as now related. He at length became greatly alarmed for his safety, and was in continual fear that he would expire suddenly when in bed. It was not till this period, which was his 2 2d year, that he resolved to lay aside all those bad practices which he now concluded must have given origin to his present state. Soon after this, he first had connection with a female, and this he repeated in moderation for a considerable length of time. He was now sensible of a great improve- ment in his health, the palpitation of his heart ceased, and he became somewhat cheerful in com- pany ; but still his mind was weak, unsettled, and so easily agitated, that it alone threw a damp on all the pleasures of life. From his 2id till he arrived at his 26th year, he occasionally used cold bathing, which he thonght yielded him momentary relief, but produced no permanent good effect on his health. He at length. 170 however, found that he had no inclination for sexual intercourse, nor were his powers in that way so vigorous as they had been for some time before. He now tried the effect of nourishing diet, and re- gularly used mineral waters for two seasons, which he thought of advantage to him. About his 29th year he was greatly improved in his general health, his mind was at times cheerful, and even happy, more so than it had been from the age of 14 or i5. In short, in respect to his feel- ings, he was quite a new man One morning about this period while in bed, he experienced the most unconquerable desire for sex- ual connection, but not having it in his power to gratify his desires at the time, he had recourse, the first time for five or six years, to his old habit. He was immediately after seized with a degree of stu- pidity, and a kind of derangement, different and much more distressing than he had ever before feit ; a profuse sweat, too, instantly covered his whole body, so as to render his linens quite wet. He de- clared he never was in such a state of complete misery, and he earnestly wished that every moment might terminate his existence. He suffered a sort of delirium, yet was sensible of his state : He leaped out of bed and bathed his face in cold water, but this only seemed to increase his sufferings ; he put on his clothes and stalked about the house like a person in despair ; he drank several glasses of wine, then ardent spirits, but they had no effect on him. After this he went back to bed, to endeavour to procure some sleep, and the spirits he had used assisting him, he slept about two hours He was now somewhat refreshed, but still his mind was very much and strongly confused ; he felt as if afraid of entirely losing his reasoning faculties ; indeed he assured me that language could not convey his feelings at that time, and for nearly two years after^ when he applied to me. 371 It is strange, that this patient scarcely had an emission oftener than once in eight, ten, and some- times fourteen days; yet it is evident, that the ef- fects produced on his general health, arose from the generative organs, caused by the same means which had, in all my patients, occasioned seminal emissions. Previous to his application me, he used bark and wine, and carbonate of iron, which considerably im- proved his digestive organs, and even his general health ; but still he was stupid, and, as he expressed himself, strange even to himself. As there seemed to be no symptom or affection of any organ to contraindicate the administration of the cantharides, I did not hesitate to prescribe that medicine to this patient, according to the me- thod formerly adverted to. I at the same time recommended the use of the cold bath. He took the medicine eight months and two weeks, before he experienced any thing more than temporary relief from it. He had frequently, for a day or two, experienced greater comfort than be- fore its administration, but he uniformly relapsed into his old state. At the end, however, of the above period, he felt sensibly invigorated ; his mind was more chearful, his testicles were not nearly so relaxed as formerly; and his penis, which had shrunk considerably under his abdomen, was greatly elon- gated. He, however, continued the use of the medicine about seven months more, and he is now perfectly recovered. His mind is still occa- sionally gloomy, but that is of short duration ; and upon the whole, he enjoys his life with consider*- able comfort. I have only met with one case of seminal emis- sion, where, from the deranged state of the parts. 172 occasioned by the disease, they could not he restor- ed to their healthy action. The emissions entirely disappeared, at least did not return oftener than once in two months, and every symptom, such as the painful erections in the night, horor of mind, and general debility, also disappeared ; but still there existed a disagreeable sensation in the parts of generation, for which no more than temporary alleviation could be obtained. The patient con- tinued the use of the cantharides about eighteen months, and in every respect, except the above sensation, has now completely recovered his health. He has taken no cantharides for these five months, and still he continues stout and active, and in bet- ter general health than he has enjoyed for many years. Of Diseased Prostate . There are few, perhaps no well authenticated cases, of a cure having been affected in diseases of the prostate gland, where the cause is not venereal. Topical applications are here of no use. Almost the only relief, I believe, which we can expect, is by the occasional introduction of a bougie or catheter, to draw off the ur ine when it becomes trouble- some. Of Gleet . I shall now proceed to point out and illustrate, a variety of peculiarities and circumstances respect- ing the cure of gleet, of which the safety of the pa- tient requires that his medical attendant should be well aware. Gleets have sometimes disappeared spontaneous- ly ; though, when neglected at first, they have more frequently baffled all the means that were employed to remove them. 173 Sometimes they have been unexpectedly remov- ed by such means as induce an inflammatory action of the parts ; as irritating substances thrown into urethra, a bruise, a fresh gonorrhoea, the superven- tion of chancre. “ * I knew a gentleman,” says Mr Hunter, “ who threw into the urethra, for a gleet of two years standing, Goulard’s extract of lead, undiluted, which produced a most violent inflammation ; but when this inflammation went off, the gleet was cured.” My brother communicated to me the following instance of gleet cured by a bruise. “ I knew a dragoon officer in Villiers’ regiment, who was cured of a gleet of eighteen months dura- tion, by an injury done to the penis. He was thrown out of his seat when hunting, and his penis was so severely squeezed between the pummel of his saddle and his pubes, that a violent hemorrhagy ensued ; this was succeeded by a very considerable degree of inflammation, pain, and the secretion of puriform matter ; and when the inflammation sub- sided, he found that he had got rid of the gleet. That gleet is often removed by a fresh gonor- rhoea, is familiar to every one. “ I have seen a chancre,” says Mr flunter,” page 220, “ coming upon the glans, absolutely cure both a gleet, and an irritation all along the passage of the urethra. So great was the irritation in this case, that I suspected a stricture, but, on passing a bou- gie, found none. I have seen this sympathy extend over the whole pubes, and so strong, that touching the hairs gently on the pubes, has given disagreea- ble sensations, and even pain.” Facts of the same kind have came under my own observation. * See page 104 of his book on Venereal Complaints. * Fordyce thinks, that gleets are continued by the remaining venereal virus, and, accordingly, are to be removed by its antidote* mercury, “ If the bougie passes freely, you will do well to set about the cure, by a proper quantity of mercury rubbed on. “ This quantity can, I think, be ascertained only by the change brought upon the matter in respect to its colour, or consistence : where such change does not take place, as will sometimes happen, I rub on. three or four ounces, so as scarcely to leave the possibility of a pocky cause remaining.” What he says here concerning the changes of the matter, shews that it was not the pocky cause, but the atony of the parts, that he removed, by in- ducing inflammatory action, or rather the suppura- tive stage. “ How many obstinate gleets,” says he, “ of two, three, or four years standing, have we seen effectually cured by a mercurial inuncection ?” This is one the many instances which show, how powerfully hypothesis influences our minds, and vitiates our reason. He never dreamed, that these complaints might have been much more easily cur- ed, by the other means that induce inflammation, quite independently of any such remedies as may remove a pocky cause. The cases, called by Mr Whately gonorrhoea, which he cured by the stimulant injections of the muriate and submuriate of mercury, were those of such gonorrhoeas as are synonymous with gleets; and I would venture to make a similar remark on the cases of gonorrhoea and leucorrhoea, which Pearson and Blair treated with such acids as the nitrous. They were at one time successful, at another unsuccessful, because they did not care- * Fordyce’s Review of the Venereal Disease, 2d edition, p, 51, of Gleets, § 8, 175 fully discern the difference in the diathesis, when these remedies were exhibited. Mr Hunter is of opinion, that the consequence of gonorrhoea is often incurable, (page 34 .) “ These diseases may be considered only as an inconve- nience entailed on those who have had venereal gonorrhoea JVo certain cure for them is known; they are similar to the fluor alkus in women. But I affirm, with no small degree of satisfaction, and the cases to be related will prove wdiat I af- firm, that such gleets and huores albi as Mr Hufi- here pronounces incurable, are just the same as those which have completely disappeared during the internal administration of cantharides. Mr Hunter, mentions these diseases in terms much too mild ; for every practitioner must have known, from his own observation, that they are not only inveterate, but have the most distressing consequences. Falck was well aware of this. “ There is,” says he, (p. 132 ), “ something so very gentle in the sound of a gleet, that the patient is very little concerned at it ; and too frequently less so, the practitioner he applies to : for my own part, I had rather cure ten recent virulent claps, than one old standing gleet.” Although, for a considerable length of time, gleet is only a local disease, yet the application of local means seldom, except in the most trifling cases, ef- fect a cure. But stimulating remedies, being ap- plied to the general system, the parts affected, as a part of the whole, are restored to their healthy ac- tion. I would not be misunderstood, when I speak of curing gleet by a stimulating plan ; for, irregularity in diet, indulgence in strong liquors, excess of ex- ercise, all do harm in every case of gleet. These complaints, I have found to be most successfully treat- ed by moderately nourishing diet, and gentle exer- cise, the internal use of the balsams, bark or the 176 Carbonate of iron, sea bathing, with injections of the infusion of cinchona, or of the quercus robur and kino. Sometimes, however, these means only serve to alleviate the complaint ; and the discharge con- tinues of a puriform appearance and consistence. When this occurs, it should be treated as a confirm- ed gleet, I have, in a former part of this work, pointed out these varieties, or rather various states of gleet, which I recollect to have occurred in practice ; and, I believe, there is no instance where the treat- ment should be exclusively local, or exclusively con- stitutional ; for in all cases we must attend to the stomach and bowels, and to the state of the discharge from the urethra. In some cases, our treatment must be chiefly constitutional, and in others chiefly local. In cases of confirmed gleet, accompanied with general debility, our treatment must be chiefly con- stitutional ; for here no stimulant injections into the urethra can in the least promote a cure ; nay, I af- firm, without hesitation, because I have really seen it happen in analogous cases, that local applications, used even so strong as to destroy the parts altoge- gether, would never induce healthy inflammation ; but when the system is assisted by internal reme- dies, this healing action can be induced and main- tained with safety, without the necessity of any acrid local applications. In cases of mild or incipient gleet, where the health is sound, we may, at first at least, trust to lo^ cal means. There is one local aoplication, which, although in many thousand instances injudiciously applied, has been of the greatest utility, and which should certainly not be overlooked,— I mean the bougie. There are plethoric habits* although not very commonly met with, enjoying to all appearance health and vigour, which yet cannot well bear either the antiphlogistic or phlogistic regimen. 1 71 tn these habits the constitution may be otherwise sound, yet there may be great atony of the penis, and an obstinate gleety discharge, so that the com- plaint is, as far as can be in a system constituted like ours, completely local, and yet does not yield to the cold bath, cold ablution, stimulant nor seda- tive injections ; but a tolerable thick bougie, prepar- ed after the manner of Le Dran, besmeared with olive oil, containing tinct. opii, will distend the ure- thra, promote the circulation there, and throughout the vicinity, induce inflammatory action, and the formation of laudable pus ; and, in flue, complete the cure. So that we have a most excellent resource, when constitutional means are not indicated, or would be detrimental, and when the more common local and external means are ineffectual. There are others, who, though they can scarcely be deemed of very sound or healthy constitutions, yet enjoy their usual health. Such are people pre- disposed to apoplexy, to phthisis pulrrlonalis, asth- ma, &c. when they take such medicines as excite the system* they are seized with headache, vertigo, breathlessness, or similar symptoms. In such cases, when injections have failed, we shall often succeed by the bougie To some persons, however, the bougie is intolerable. But though, in particular cases, internal stimu- lants are dangerous* injections ineffectual, bougies inadmissible* we are not without resource; for vesi- catories, applied to the perineum, will, in many in- stances* remove the disease. Thus we see how necessary it is to attend to pe- culiarities of constitution, and to vary our means of cure accordingly. No man’s genius was ever more fertile in expedi- ents, in difficult cases, than that of Mr J. Hunter; and as his experience with regard to vesicatories, in M 173 circumstances somewhat similar to those in which I would advise their use, completely corresponds with my opinion of their utility, I hope I shall not be blamed for quoting the following very instructive facts and observations : * iC A blister applied to the perineum will entire- ly cure some of the remaining symptoms, even when they extend towards the bladder, as will be explained hereafter ; indeed, it appears to have more effect than any other remedy. A blister to the small of the back will also give relief, but not so effectually as when applied to the perineum “ This practice,” continues Mr Hunter, was not his only mis- fortune; heauaeh, loss of appetite, lumbago, incon- tinence .of urine; in fine, general emanation and debility, threatened the speedy termination of his life. All the most common means had been employed to remove his complaint ; accordingly, to make him 383 undergo a repetition of the same, was neither con* sonant to my feelings, nor to the state of my patient. I therefore prescribed for him the tincture of can- tharides, which he continued to use, progressively increasing the doses, for about a month, when his complaints disappeared. He left this city soon afterwards, and repaired to London, where his family were ; but his kind wife, expecting nothing more than she had for many years received, made no demands, and he, for his part, did not endeavour to convince her of her mis- take, but exerted his powers in a way not quite so legitimate as moral probity could wish, ol which there in a short time appeared living evidences. This patient, however, had a return of his semi- nal emissions, but by a perseverance in similar treat- ment for a few months, he entirely recovered. CASE. A Gentleman, aged 23, had laboured under a gleet for some years ; he applied first to a sur- geon in town, who gave him the common injec* tions. They arrested the running for a short time, and when it returned, he applied to another surgeon, who advised the balsam of copaiva ; and, after he had used it for about a month, bougies were em- ployed. Their introduction gave him little unea- siness, and their use did no service ; he recom- menced the balsam, but in vain. Sometimes, in- deed, these remedies seemed advantageous ; but the disease was now worse than ever. I told this gentleman, that I had more than once experienced the most complete salutary effects from a certain method of treating gleets, which I had adopt- ed within these few years; but that I could scarcely advise him to attempt it, on account of his extreme irregularity of living, as it would require uncommon attention, both on his part and on mine ; otherwise M 4 184 the consequences might be very troublesome, if not dangerous He replied, I had nothing to fear, since his passion for the fair had lost its predominance. His general health was much impaired, and a very small proportion of wine or ardent spirits, intoxi- cated him. He said, too, that it was out of his power to remain in town, but that I might pre- scribe without fear, as he was resolved to obey my injunctions most minutely. Accordingly, I gave him a portion of the tincture of cantharides, and he was instructed to pay the utmost attention to any change that might occur in the state of the dis- charge ; whether pain supervened in the penis, kidneys, or stomach, or any difficulty in making water; and if such symptoms occurred, to intermit or diminish the doses of the medicine, according to their severity ; but if they did not at all inter- vene during its use, to let me know in time, that I might transmit him a supply, before the first quan- tity was finished. Consequently I received a letter from him stating, that no pain had troubled him, and requesting to knpw how he should next proceed. I ordered him a second mixture like the first, but to be taken in increased doses : he had only taken of it a few times, when he was seized with excruciat- ( ing pains in the pans of generation, with an almost complete strangury : he now ceased to use the cantharides, till he should receive farther instruc- tions. i wrote him instantly to bathe the parts with warm water, to take a cathartic, and use the injection into the urethra, with both ot which he was furnished on his departure from town ; request- ing him, at the same time, to let me know r , by re- turn ot post, how he should feel, after he had ob- served the directions then given,; but l got no o- ther information concerning this case till several months aiterwards, w hen 1 saw him in town ; he was then married ; and I had the pleasure to receive 185 thanks for having accomplished in him a perfect cure, CASE, i A Gentleman, aged 32, stout and active, contracted a gonorrhoea, which, in consequence of inattention, was not removed for more than two months. Six months after he perceived a slight gonorrhoeal discharge, but was willing to allow that he had ex- posed himself to a fresh infection. He now used injections, nitras, and supertartris potassae, and the cold bath daily, with apparent ad- vantage ; but the least irregularity in diet or exer- cise renewed the discharge. He at length became tired of medicines, and confined himself to the cold bath once a-day ; all pain was gone ; but the discharge and debility of these organs proceeded increasing. Wherefore, by my advice, he commenced the use of the tincture of cantharides, but, as he scarcely expected any ad- vantage from the medicine, did not use it with any punctuality ; he however increased the doses, re- covered completely, and is now married, and re- mains well. CASE. A Gentleman, aged 25, was affected with gon- orrhoea, to remove which he employed the common means with success. 1 he discharge had never been very copious, was of a glairy appearance, and he suffered much from a continual soreness in the urethra, about an inch from its external orifice, but did not think, that the stream of his urine was smaller than for- merly. 186 He had lately been living rather irregularly, and now complained of incontinence of urine. I wished to introduce a simple bougie, to ascer- tain the state of the urethra ; but he would not allow it to be done. I then prescribed the tincture of eantharides for a few weeks, when the discharge diminished gradu- ally, and at last disappeared, leaving, however, a certain sensation, scarcely to be called uneasy, in the urethra, particularly on making water. He went into the country, had much exercise on horse- back for some days, got himself frequently wet, and also exposed himself to a new infection ; soon after which, the discharge returned, and the sensa- tion went off. This new discharge was whitish, •watery, and very copious. Are we to consider this a new infection, or as the effects of the former disease not completely cured ? We are to observe, that there still remained a certain sensation in the urethra, which went off when the discharge returned; and that the new attack was neither ushered in, nor accompanied with inflammatory symptoms ; and when we re- collect, that gleet often succeeds gonorrhoea at some distance of time, it is not improbable, that the peculiar sensation above described, was a relic of the inflammation which the eantharides had ex- cited, which terminated in the atony of the parts, and a removal of the gleety discharge. There are some particular circumstances, which, in some measure, invalidate this opinion. The dischage at first was not of a very inflammatory kind, nor very copious, but became very copious during the complaint ; but there was a continued pain and soreness in the urethra after the first attack, which has, on the second, entirely gone off: but, had it been a fresh infection, have we 187 not reason to think, that the pain would have been renewed ? On the whole, then, I am inclined to think, that this was a relapse of the former complaint I again wished to introduce a bougie, to ascer- tain the state of the urethra ; but he would not suffer it. On the idea that this was a relapse of the affection, I advised him to resume the use of the tincture of cantharides , but he refused this also, saying he was tried of it. I then gave him an injection of sulph. zinci, expecting, that the in- veteracy of the discharge would at last induce him to re employ that remedy, which had already been of service to him. He used the injection occa- sionally, but the discharge continued unabated. In the beginning of August following, he inform- ed me, that having indulged himself lately with a female friend, a great quantity of blood flowed from his urethra during the night, and next morning he found that the gleety discharge had nearly dis- appeared, and with it the disagreeable feeling which had again attacked the urethra. I ordered him to continue the use of the injec- tion. He told me, about twelve weeks afterwards, that his complaint had entirely ceased, and that he had long given up the use of the injection. This event seems to confirm the opinion which I had formed of this occurrence ; for, is it not pro- bable that the discharge proceeded as a proof of the correctness of his reasoning, and of the simplicity and ease of such practice, is as fol- lows : — His first essay was upon a small scale, and simple enough ; from Mr Hunter’s respectability he gained applause, or at least, from that circum- stance, he, on that occasion, escaped reprobation ; he ventured a little farther ; proposed something in addition ; but still, for the most part, on such occa- sions, he took care to shelter himself under the wing of Mr Hunter’s well-earned reputation till at last, finding himself pretty nearly in a wav that he thought warranted him to speak and act entirely for himself, he boldly asserted, that many of the more impor- tant diseases ascribed by nosologists to other causes* depend entirely on stricture in the urethra. I give the consulting surgeons of London, in ge- neral, every credit for the superiority of their powers in the performance of the most difficult operations. Indeed, I believe, that at present they are, with the exception of one or two individuals, superior in that respect to any in the world. But in the discrimination of diseases, I would reverse the statement ; for 1 really think, that the proportion of them who can do this well, is not so great as might naturally be expected. 221 Medical men, with their hands combined with the heads of some of those in other parts of the world, would have the most decided success, as well in rea- soning, as in the performance of many operations, which, in their divided state, are but clumsily ma- naged. Mr Sharpe, I may observe, when treating of the subject of strictures in the urethra, informs us, that “ at present, it (the caustic) is universally con- demned, and has been so almost since Saviard’s time. His objections to the use of caustics, were the difficulty and almost impossibility of directing them, so as to eat through all the diseased parts of the urethra, without destroying the sound parts ; the impracticability of preventing the urethra from contracting when it healed , as much if not more than it was at the time of applying the escarotic,’ &c.” To the authority of Sharpe and Saviard, against the indiscriminate use of caustic, I may add that of Pare, Wiseman, Le Dran, Astruc, Pott, and ma- ny others, whose respectability and eminence can- not be questioned. These objections may with equal justice be always urged against this practice, even where parmanent strictures are formed, and far more so when we find it indiscriminately appli- ed, where there is no permanent stricture at all ; nor will even the authority of Mr Home, for the ease attending its application, and its safety , over- turn them. The authorities quoted, to men who know how to reason, have always been as good as Mr Home’s, and will probably remain as long so. Mr Whately has, in his defence of the applica- tion of caustic, attempted to draw a comparison be- tween its effects and that of the more active medi- cines used internally ; but the comparison is not fair; we can dilute the medicines, and use them in any quantity we wish, but w T e must use the caustic in full quantity, and in its greatest strength and ac- 222 This gentleman, however, has, in his pamphlet on Mr Home’s practice, given a very neat con- densed view of the effect of Mr Home’s bougies, in his treatment by caustic of obstructions in the ure- thra. His criticisms seem correct, and are certain- ly those of a gentleman and a man of liberality ; yet even he, in some of the cases subjoined to these criticisms, has used the caustic in pure spasmodic stricture, and consequently subjected the patient to much unnecessary distress. Mr Whately justly ob- jects to Mr Home’s introducing the caustic bou- gie into the bladder, from the chances of carrying along with it, and depositing in that viscus, any of the liquified caustic. This is an objection which certainly deserves consideration. In a note in page 30, of Mr Wadd’s pamphlet, he informs us, that “ to a gentleman, with whom he was well acquainted, it (the caustic) w^as applied upwards of fifty times to a supposed stricture near the neck of the bladder. When he died, the ob- struction was discovered to have arisen from an en- larged prostate giand. The caustic had eaten an inch into the substance of the gland." Many other instances of a similar kind, he informs us, might be enumerated. Yet it is passing strange, that on reading Mr Home’s book, we find the application of the caustic neither occasions pain to the patient, nor difficulty to the surgeon. Communications which I have lately had from many parts of the country, respecting these diseases of the generative organs, proves, that the caustic bougie had in them not only been unsuccessfully applied, but had, in some instances, created the most afflicting and irremediable distress, to which it was possible to reduce an unfortunate patient. In others, where this practice w r as not carried so far, I have easily removed their complaints by the in- stantaneous adoption of more simple means. Even allowing all the cases Mr Home open- 2 23 ated for with his caustic bougies, to have been permanent strictures, the frequent recurrence of af- fection, always in an aggravated degree, and the ne- cessity there was, in some instances, of applying the caustic often for a great succession of years, (several hundred times in some instances ,) completely prove, that from such an application, we have no right to expect a radical cure, except in the very slightest cases, and that only, when the contracting power has quite abated. Were no other mischief to follow the application of caustic to the urethra, but the excessive hemor- rhage, which is confessed, even by authors who are advocates for this barbarous practice, to be a very frequent occurrence, that alone would deter any one from its constant use. These authors, however, talk with much coolness, even when six or eight pounds of blood have been discharged in this way. Various cases are related by them of the ease and safety of such bleeding. Mr Wadd, however, very properly takes another view of the subject : “ In one case,” says he, “ after the eighth application of the caustic, on withdrawing the bougie, I was in- stantly covered with blood, which came out, with a jet, nearly equal to the flow of urine. I must con- fess, whatever those accustomed to such accidents may think of it, that I was greatly alarmed ; and as it happened in my own house, it was the more embarrassing ; pressure and cold applications were used in vain, and it was some hours before it became sufficiently moderated to allow the patient to be car- ried home in a sedan chair The bleeding continu- ed at intervals, for several days ; and it was five months before the patient, who was a foreman in a manufactory, had recovered his strength sufficiently to resume his station.” 4 However far,” Mr Wadd properly remarks, “ habit may teach a surgeon to regard these circumstances with indifference, he will not so easily succeed in making the patient, or his 224 friends believe there is no danger, and that extreme debility is a matter of no consequence.’* Mr Carlisle informs us, in the 3d volume of the Medical and Physical Journal , that a young gen- tleman, to whom he applied caustic for a stricture, near the bulbous part of the urethra, had a hemor- rahge produced by it, which continued seven days ; in the two first, he lost four pounds of blood , and nearly as much afterwards, Mr C. has heard of some other persons who have actually died of this kind of hemorrhage. Strictures, however, of a truly permanent nature, can only be removed by the various modes recom- mended by authors for their entire destruction ; such as the various ways of applying caustic sub- stances, and even some may probably require inci- sion. Mr Hunter conceived the caustic properly appli- ed, only under the following circumstances : “ First, where the stricture is so tight, as not to admit the smallest bougie to pass Secondly, where the ori- fice in the stricture is not in a line with the urethra. Thirdly, where the passage has been obliterated by disease, and the urine passes by fistulae in perinoea.” Had Mr Home followed Mr Hunter in these plans of practice, and not taken him along with him, as he always does, merely to support him in his diffi- culties, he would perhaps have prevented many an unnecessary scene of misery to several unfortunate individuals. I have found, that where permanent stricture ac- tually existed, and where it was absolutely necessa- ry to apply some substance for its removal, the mode either for application of the lunar caustic, or the ka- li purum , as recommended by Mr Whately, is pre- ferable to any other with which we are at present acquainted. The first of these substances is secured in the form of powder, to the end of a bougie, by means of common glue, and before being applied 225 to the obstruction, has a thin covering; of bees wax laid over it 1 he other is introduced inro a hole, about the size of a pin’s head, made in a common bougie, and covered with hogs lard Either of these substances, when applied for a short time to the stricture, is dissolved, and produces its effects by de- stroying it. In this way. the membiame of toe ure- thra is not so liable to be injured, as in the other modes of applying caustic substances ; but still it must, in many instances, suffer; for when the caus- tic becomes liquified, the disposition of all matter, and these in common with others, to run toward the orifice of the urethra, must greatly injure or entirely destroy the membrane, anterior to the stric- ture. Even, however, where it has beyond doubt been ascertained, that permanent strictures exist, the use of internal medicines and external applications, during our attempts to remove them, are absolutely neces- sary. Because, in all such strictures, even of a per- manent nature, there is, according to the time they have existed, some degree of spasmodic action still remaining in them, which, in almost every instance, cannot suffer dilatation without these applications being previously made. Still, any contrivance, however ingenious for the application of caustic to strictures, must be liable to the insurmountable objection mentioned above. What I allude to, is the impossibility of preventing the caustic, liquified by the moisture of the parts, from spreading over and destroying an extensive and healthy surface, particularly anterior to f thin mat- ter flowed out by it ; and unless the sinus was thus emptied every morning and evening, the pain was c c 3 406 very severe. But the motion of her elbow-joint was not impeded for more than a month after, from which time she, by the advice of her medical atten- dants. used, at different times, various kinds of ointments, but never reaped any sensible advantage from their use She also had setons introduced at parts somewhat distant from the ulcer, but, as might have been expected, she derived no advantage from them. She came to Edinburgh from the country, and gave me the above account of her complaint, and the medicines employed to remove it. She said, that she never felt any swelling in her neck, axilla, or groin, except last winter, when, after having ex- posed herself to dampness and cold for a con- siderable length of time, she felt several swellings on the right side of her neck, one as large as a pi- geon’s egg, the rest smaller ; hut they soon went off. There was no other opening than the one already described, immediately over the outer condyle of the humerus, which scarcely admitted the point of a small probe, and still discharged the same kind of thin matter, nearly a table- spoonful of which I pres- sed out of it I first introduced a probe, which pas- sed along the sinus downwards without obstruction, or causing the least pain ; and, on withdrawing the instrument, there was an increased discharge of thin matter, i next introduced the probe about two inches upwards, with the same ease. In short, this sinus commenced about two inches above the elbow-joint, on the radial side of the olecranon, crossed the joint obliquely, and then proceeded about six inches along the posterior part of the arm, in the direction of the ulna, where it re- ceives the interosseous ligament. I laid this sinus completely open. On examining, I found other three sinuses communicating with the first, and laid them all open. I dressed the wound once a day with strong oint- ment of axunge and the red oxyd of mercury, and 407 bathed it with a strong solution of sulphate of cop- per ; neither of these applications gave pain, more than five minutes after each dressing. I continued to employ similar treatment for about three weeks, during which the ulcers often seemed to assume a tolerably healthy appearance ; but, on examination, finding more extensive and deeper si- nuses, I abandoned these, and prescribed the inter- nal use of cantharides. After continuing the use of this medicine, pro- gressively increasing the doses sufficiently to af- fect the urinary organs, for about ten weeks, she completely recovered. During this cure, I made it a general rule to open all sinuses the moment I discovered them, and washed the wounded surface with spirits, and some- times dressed it with escarotic substances. When the parts had assumed a great degree of healthy ac- tion, I applied pressure to the sinuses with the greatest advantage. The glands of the neck and axilla swelled ; but, by cold applications, and dimi- nishing the use of the cantharides, with the admi- nistration of some cathartic medicine, they were subdued. It is now about four years since I cured this pa- tient, she has had no return of her complaints, and can use the arm in every respect with the utmost freedom. CASE. A Gentleman, aged 35, lame, and of a weakly habit of body, applied to me with a small tumour of a livid colour, situated about three inches toward the right side of the thyroid cartilage, which evi- dently contained fluid matter ; but he would not submit to have it opened, and went into the coun- try. He soon returned, and informed me that the tumour never had increased beyond the size of cc4 408 a small walnut, and had never given him pain. It had broke, and discharged thin matter ; and a sur- geon in that part of the country advised him to ap- ply a poultice for a few days, and afterwards to dress the external sore with ung basilic. He continued, however, to observe these instructions, without be- nefit, till he came to Edinburgh. On examination, J found two small openings discharging thin acrid matter in great abundance. I introduced a probe, which passed easily forward over the anterior surface of the trachea forming a cavity of considerable ex- tent. By dissecting off the integuments, I laid the sinus completely open, and thus an ill-conditioned ulcer was formed, extending three inches across the fore part of the neck, and one and a half from above downward. I prescribed the tincture of canthari- des, which soon affected him in the usual manner. The ulcers were occasionally opened, when any of them assumed the appearance of sinuses, and wash- ed with spirits. In six months he had completely recovered. CASE. Mrs , aged 44, of a slender habit, ap- plied to me for assistance. About a fortnight be- fore, she had exposed herself to dampness, and fa- tigued herself much. Towards evening she felt coldness, shivering, and feebleness. The shiverings continued, and she slept very little all night, but they went off next day, and she thought herself much better In the course of a tew days afterwards, she was seized with stiffness in her neck, and a swelling made its appearance about the angle of the jaw, on the right side. Several of the glands on the same side were affected, and they continued to increase in size till i saw her. From the ear to the top of the shoulder, the neck was of a dark livid colour. Fluctuation being distinctly felt in the tumour, I 409 opened it, and there was discharged a large quanti- ty of clear thin fluid, mixed with coagulated lymph. The internal surface of the ulcer was very extensive and deep. I washed it, and injected equal parts of tinctura opii and alcohol, which gave very little pain, and dressed it externally with simple cerate. All the glands of that side of the neck suppurated and broke, and several sinuses had formed, which were laid open, as far as could with safety be done. At length the ulceration and sinuses occupied all that side of the neck, and seemed disposed to ex- tend in every direction. The whole length of the sterno cleido mastoideus muscle was detached, ex- cept at its origin and insertion ; and from the whole wounded surface, there was discharged thin foetid ill-conditioned pus, in great abundance. The most stimulating dressings I could think of were now ap- plied, and injections of equal parts of tinctura opii and alcohol were used twice a day, and bark and wine internally ; yet new sinuses were daily forming. Though some parts of the wounded surface now and then assumed a tolerably healthy appearance, this seldom continued more than a day or two, when they degenerated again into their former un- healthy state. Every external stimulant application being inef- fectual, and the patient’s health sinking, in conse* quence of the great discharge, I began the use of the tincture of cantharides internally, in the usual doses. After she had used this medicine some time, I was informed that she had been affected with Jiuor at - bus for many years, but that she now was afraid of it ; for the matter discharged per vaginam was be- come very thick. It was found necessary still to open some very large sinuses, which run parallel to the edges of the sterno cleido mastoideus, and a deep tumour behind the ear, from which pure pus was discharged \ and by a probe I ascertained that the 4 ;0 the matter had insinuated itself between the intersti- ces of the more deeply seated muscles. By means of keeping the ulcers on :he neck clean, and apply- ing dressings of simple cerate, and pressure, to them, with the internal influence of the cantharides, the livid colour changed into a florid red ; granulations formed ; the detached portions of the muscles gra- dually adhered ; the Jluor a/ bus disappeared, and she was in a few months completely cured of her com- plaints, and even now enjoys the very best health. CASE. A wood-cutter, aged 24 stout made, was about seven years ago affected with scrofulous swellings in several parts of his body ; but only those of his neck suppurated and broke He applied to me on the 22d of April 1 8()6 ; and as it may be of some importance to convey to the reader an idea of the general appearance of his disease, I shall attempt to describe it. On the right side of his head and neck there was one ulcer, between the sterno-c eido-mastoideus and masseter , extending from the lobule of the ear to the angle of the inferior jaw, and discharging matter by two orifices. There was a second ulcer, about an inch from the former, situated on the cheek, its upper edge being opposite the termination of the parotid duct, itself extending downwards, uniting with another ulcer under the maxilla, and stretch- ing along in that direction. These discharged mat- ter by four orifices. Another ulcer was situated be- tween the trapezeus , and sterno-cteido-mastoideus , and extending across the infeuor extremity of the pla ysma-myoideus to the slerno-hyoideus. A very large ulcer extended from the inferior edge of the thyroid gland, over the sternum to the insertion of the second pair of ribs, and was covered with scabs on this side. There was also an ulcer running 411 across under the chin, which united those on oppo- site sides. On the left side, the ulcers were much more ex- tensive than on the other, and not so capable of the same description They seemed, however, to form three lines, one commencing behind the mastoid process, extending downwards till near the acro- mion. The second from behind the lobule of the ear to the anterior half of the clavicle ; and the third from the zigomatic process of the temporal bone, over the masseter and upper part of the platysma-myoideus, joined as above described with the ulcers of the op- posite side. The matter was discharged here by numerous orifices, and approached somewhat to the appearance of laudable pus. His neck was in gene- ral very much enlarged, it being at least equal in circumference to any part of his head. The axillary glands were but slightly enlarged, but all the glands in both groins, along the course of ponparts ligament , and extending down upon the inside of the thigh, were universally enlarged. , The disease began by the ulcer above the trachea , which broke about five years ago, after having been in a diseased state fully two years; and all the other part mentioned about the neck becoming also affected, broke three years ago. The whole neck and face con- tinued more or less swelled. The general health, how- ever, continued all the while pretty good, except from time to time severe pains in the bowels affected him, which were eased by the discharge of flatus down- wards. He does not recollect if he was at these times costive. When he applied to me, he complained of loss of appetite and sickness, in consequence of which he had been unable to work at his trade for several months. From the general tendency to glandular swellings in this case, 1 conceived it more prudent to employ the solution of the muriate of lime, than the cantharides ; as in several cases of very large glandular swellings, I found this medicine, when 412 used in large doses, from four drams to an ounce each day, of the greatest service. I know that this valuable medicine, like many others, has been near- ly consigned to oblivion, from an idea propagated by men thought to be eminent in their profession, that it is possessed of no useful quality ; but this is not very uncommon in our profession; for, unassist- ed by reasoning of any kind, one medicine after another has been applauded, has retained its popu- larity for a length of time, and, as might be expect- ed, has at last been completely neglected. Not that the medicine warned power, but that its em- ployers wanted judgment, i prescribed this medi- cine to be taken at first in doses of half an ounce per diem, to be gradually encreased. I at the same time prescribed as tonics. Peruvian bark and carbo- nate of iron, to resto>e the appetite and promote di- gestion, desiring that the ulcerated parts should be bathed with warm sea water, and dressed with sim- ple ointment. On the 30th of May I prescribed a solution of the sulphate of copper in water, to wash the ulcers, and desired that the muriate of lime should be con- tinued. A tumor appeared, situated over the jaw, and directly under the dens caninus , which in two days became as large as a walnut, and seemed com- pletely filled with matter. On the 7 th of June this tumour had shrunk and nearly disappeared, without any external opening, and the fluctuation of matter was scarcely to be felt in it. The ulcers had a more healthy appear- ance than he says they have had since the com- mencement of the disease. Np new swellings or ul- cers had broke out since he began to take the muri- ate, and he was now able to work at his trade, was free from sickness, and took his victuals well. On the ' 29 th I repeated the mixture as formerly, the patient still continuing to get better. On the i 1 th of July the swelling of the glands 413 was greatly removed, but the ulceration was worse, and very universally snread all over his neck, for he most part in small distinct pustules, discharging thin white matter, I now determined to give up the use of the muriate, and try cantharides, which I had hitherto declined doing, on a count of the swelling of the glands ; but, as he was obliged to return to the country, before he could arrange matters to stay in town during their use, he therefore did not be- gin to take them till the 9th of August. The ulcers were still discharging unhealthy mat- ter, and there was a tumour thes ze of a walnut, al- most above the trachea, in which matter evidently fluctuated. I prescribed the tincture of cantharides to be taken in the usual doses. He continued to use this medicine, without any perceptible effect, till the evening of the l*2th. While in bed he felt intolerable itchiness all over his body, and, on examining hi> skin, he discovered blotches of the size of a shilling completely covering him, and appearing as if he had been stung by nettles. On the i 3 thj he informed me of the above cir- cumstance, when the blotches had almost all dis- appeared, and he felt a kind of soreness in several of the parts where they had b en. He had taken none of the mixture since last night, being terrified lest the blotched appearance of the skin should re- turn. The discharge from the ulcer was of a thin wa- tery appearance, except in one small spot under the right ear, from which thick white matter was dis- charged, in greater quantity than was poured out by any of the ulcers of a similar size. No effect had been produced on the urinary organs. The tumour mentioned on the 9th broke this morning, and discharged thin matter. I ordered a poultice, and the recommencement of cantharides in rather larger doses On the 15 th, no effect was produced by the can- tbarides on the urinary organs, nor had the blotches troubled him again. Several of the ulcers discharg- 414 ed thin, others thick white matter ; formerly they all discharged thin ill-conditioned matter : the discharge was likewise increased in quantity, and such was the nature of the ulcers, that pressure being made on part of his neck formerly described to be in a dis- eased state, matter of different colours and consist- ence could be squeezed out as if from a sponge ; yet a probe passed but a very small way into either of the openings. I desired the doses still to be encreas- ed, and dressings of simple ointment to be used. On the lQth, the probe went much easier into the openings than yesterday. In one situated over the parotid gland, I could introduce a probe nearly an inch all round, and there was discharged from it thin matter in considerable quantity. He was now very timorous, and would not submit to have it laid open, Several of the ulcers, however, were completely healed. Some still discharged thin, some thick mat- ter. and there were several small papulae, with white tops, on several parts of the neck, which never were seen before. No effect was produced on the urin- ary organs, I therefore desired the cantharides to be continued in encreased doses. On the 20th, after he went to bed, there was some pain in his urinary organs, and difficulty in passing water, but these went off before morning. I still desired him to continue the cantharides. On the 22d, I now judged it necessary to lay open the sinus over the parotid gland, but the pa- tient would not submit to it. I therefore, for the present, declined doing any more for him. On the 1st of September my patient returned to me with a determination to submit to whatever measures I might think necessary for the removal of his complaint. The discharge from all the ulcers had become thin, and from some of them it was perfectly limpid. I found the formerly mentioned sinus over the parotid gland considerably enlarged in extent since the 22d, and I made an opening 415 from the uppermost to the most depending part of it, in length two and a half inches. I opened an- other about three inches in length, in the direction of the sterno-cleido-mastoideus. 1 likewise opened several smaller sinuses, extending two or three lines immediately under the integuments of the neck, and filled all of these with lint dipped in so vini, and or- dered him to recommence the use of the tincture of cantharides. He continued to follow this practice till about the beginning of February folio wing, when he had completely recovered. He is now, (November I 8 O 9 J perfectly well, and working at his trade. II. Diseases op the Skin. CASE. A man aged 35, about five years ago fatigued himself by walking a great deal, which was imme- diately followed by a swelling in both legs. The skin also broke in several places, and, in the course of a few weeks, there was a constant discharge from them of a watery fluid, attended with acute pain from the knees to the ankles. Mercury was pre- scribed, which weakened him very much, but did not in the least relieve him of his complaint. After he gave over the use of this medicine, the swelling began to abate, but the eruption, with the discharge, continued to extend upwards to his thighs ; and, in a few months, it covered his whole body, and even his arms to the points of his fingers. All the dis- eased surface discharged thin matter, similar to what was at first discharged from his legs, attended with some pain, but his legs were always more so than any 416 other part of his body. He then came from the country into the Infirmary of this city, but derived no benefit from the prescriptions he received there. In consequence of his disease, he had lived in great misery for four years past, during which time he had used almost every external application that whim or superstition could suggest, but derived no benefit from them. Of late he had used the citrine ointment, which he thought kept the parts soft, but did no other good. I desired him to lay aside all external applications, and I prescribed the tincture of cantharides to be used internally. This practice he continued with various effect for seven months, during which time he was often indeed much worse than before he commenced the use of the cantha- rides, but then he completely recovered, and two years after had no return of his complaint. CASE. A gentleman of delicate form and small stature, aged 6o. applied to me some time ago for the re- moval of an eruption of several years continuance in bo^h of his legs, from the ankles to the knees, and a similar affection in one of his fore-arms. These parts were greatly swelled beyond their natural size. His general health was unimpaired, but the immense discharge of thin serous fluid which con- stantly proceeded from all the wounded surfaces, and the excruciating pain which he suffered, ren- dered his existence extremely uncomfortable. This discharge seemed to proceed from all the denuded surfaces, there being no destruction of parts forming what is known by the name of ulcer. At certain periods of the year it would almost heal, even without the application of any other sub- stance than simple ointment. This partial recovery he attributed to the effects he experienced from vi- siting some of the watering places every summer ; A\7 but soon after his return home his former symptoms recurred. In this kind of comfortless manner he had lived for many years previous to my being called to visit him ; and when I proposed to employ cantharides internally, he consented to give it a trial, but ex- pected no permanent benefit from its use. After the medicine had been used about a fort- night, he felt slight difficulty in voiding urine, ac- companied by a soreness in the affected parts, from which there now issued a discharge greatly en- creased in quantity, but not altered in colour. The pain, though equally severe in the affected parts, he soon felt to be of a different nature from that which formerly distressed him.* He continued the use of the medicine for upwards of six months, with, latterly, the use of the tight roller to the affected parts, when he had completely recovered. He from time to time had slight eruptions for three or four months afterwards, but no pain, and now he is free even from them, and is perfectly well in every re- spect. A more detailed account of a few of the preced- ing cases, containing their daily progress toward their cure, may be found in my former work on the internal use of cantharides, and some others since that in the Medical and Physical Journal of London for October 1808. * This excruciating pain I have frequently met with both in diseases of the skin and in ulcers. It seems deeply seated, and in most instances, as if in the substance of the bone. This at first deterred me from using the cantharides in such affections, con- ceiving that the inflammatory effects of that medicine would en- crease the pain. But, to my surprise, in every case the former pain abated on the system becoming affected by that medicine, and the pain occasioned by the medicine itself was quite of a dif- ferent and more bearable kind. D D 418 In ah those edematous swellings of the legs, which so often occur in persons advanced in life, or in con- sequence of previous debilitating diseases, I uniform- ly effect a cure by the internal use of cantharides. After its use, however, for a week or two, I find it absolutely necessary to employ a roller or a tight laced stocking along with it, which should encom- pass the whole foot and leg to the knee ; and. even after the cure has been completed, this application ought not to be laid aside for several weeks, or even for a month or two, III. Glandular Diseases . Diseases of the glandular system, are, even in their simplest form, extremely difficult and tedious of cure I am sorry to say, that with our very great- est attention, and probably from ignorance of the particular action of some of the most valuable medicines, these diseases often prove irremediable. From this circumstance, together with the indolence of the human character, in general, those diseases have hitherto been in a great measure left to them- selves, and have too often produced spectacles of deformity and disease scarcely to be met with from any other cause. From whatever cause, then, the diseased state of the glands may have arisen, our first object (oeing the simplest and least formidable) ought to be to make a fair attempt to remov e them by internal me- dicines, or in conjunction with simple external ap- plications. But, if after this no relief be obtained, and the complaint still continues to gain ground, we must have recourse to surgical means for its re- moval. The cantharides must first be taken in sufficient doses to excite some degree of uneasiness in passing urine. This effect is the surest sign of the system in general being affected by the medicine, in the 419 same way that opium is known to affect the system by its effects on the brain, and mercury by its ef- fects on the salivary glands. A continuance of the medicine in sufficient doses to preserve some degree of uneasiness in the urinary organs, will probably at length cause some addi- tional uneasiness in the affected gland itself. At all events, even if it should not occasion much pain in the gland, perseverance in the use ot the canthandes for four or five weeks will be extremely proper; but, if pain be produced in it before that time, the can- tharides must be instantly laid aside, and other means adopted. It is at this precise period that the solution of the muriate of lime may be administered with the very greatest success ; and a blister or sinapism may at the same time be repeatedly applied over the af- fected glands. A dram of the muriate may be given in water morning and evening, and gradually increased till the doses may amount to from one to two ounces daily, divided and taken at three or four, or more different times The only bad ef- fect that the muriate seems capable of producing, is a little uneasiness or sickness at stomach, which will entirely abate on its doses being diminished, or entirely omitted for a few days. Even should the pain in the glands entirely abate, the cantharides may be given in conjunction with the muriate, and the external application of the blister or sinapism may also be had recourse to, when the good effects of such active practice ap- pears very conspicuous. But if, independently of all these means, the dis- eased gland or glands still continue to encrease our dependence must principally rest on our success- ful treatment by surgical means. A complete ex- tirpation of the diseased glands must then be eitected. d d 2 4-20 IV. Paralysis . 1 have had frequent opportunities of successful- ly exhibiting the cantharides internally in slight paralytic affections, especially such as is frequent- ly to be found among those who are in any way exposed, from the nature of their profession, to the action of the various preparations of lead on the body. But I met with one case lately of a more decided nature than I had ever seen before. The patient was by profession a house- painter, and in the prosecution of his business, both his hands, from the wrist joints, became paralytic. He Was totally unable to use them in any way ; and being at that time in London, he applied for assistance ; but, notwithstanding every thing that could be done for him, he derived no advantage. He at length came to Edinburgh, where his relations resided, and at the request of a friend of my own, I was desired to prescribe for him. From the almost complete want of feeling, and want of power in his hands, I had but little expec- tation of affording him any relief. But, being the remedy which occurred to me as the best, I pre- scribed the tincture of cantharides, to be taken in sufficient doses to preserve some degree of uneasi- ness in passing wafer, i o this was added friction, with a brush, to be used twice or thrice daily This he continued to do about three weeks, when h e thought the feeling in his hands was somewhat en- creased ; but the power of stretching them out was still denied him. He continued to take the tincture of cantharides, to produce the effects I have stated above, for other two months, but derived no additional bene- fit from it. I then omitted it, and prescribed a so- lution of phosphorus in aether. This he continued 421 to take about a month, during which time he im- proved very much, but it also, at this time, seemed to lose its beneficial effects. I then resolved to use both the cantharides and phosphorus at once, and prescribed the first of these to be taken in such doses as would, as constantly as possible, keep the urinary organs somewhat uneasy, and the latter in such doses as would create, as constantly as possible, a degree of uneasiness approaching to giddiness in the head. Under these medicines, he seemed to improve somewhat quicker than formerly, and con- tinued to do so for several weeks ; but they also seemed to lose their effects on his hands. I still, however, desired him to persevere, and the differ- ence of these two stimulants appeared very con- spicuously in this case. He found it necessary with the cantharides gradually to diminish the doses, from nearly an ounce of the tincture daily, to about one dram and a half; but the phosphorus and aether he had now encreased from two drops twice a- day, to nine drops thrice a- day, while these substances seemed to produce similar effects on the head and urinary organs, which they did when first they af- fected the system. 1 or five weeks, he felt no alteration for the bet- ter ; but about that time, a rapid improvement in his hands took place. He felt able to stretch them very considerably, and the feeling was as acute as before he was affected by the disease. I desired him still to persevere, and he could now only take about half a dram of the tincture daily, while he could use 14 drops of the solution thrice a-day. I also desired him to use cold sea-bathmg from which he derived great benefit. This patient continued these medicines for a few w'eeks more ; ^nd in a few days more than six months from the time he began the use of the tinc- dd3 422 lure of cantharides, he was able to begin the pro- secution of his business. He has now continued nearly a year free from his complaint, and can use the most violent exertion with his hands. \ % 423 APPENDIX III. Effects of the Cnntharides , with Rules for their Administration . I. External Application. Cantharides, when externally applied in suf- ficient quantity, excites great heat, redness, local pain, and general uneasiness. They accelerate the pulse, and often induce pretty smart fever. At length the feverishness abates gradually, and a thin serous fluid is effused under the cuticle, which is thus raised into vesicles of different sizes. This serous fluid being allowed to escape, or even being absorbed, the inflamed surface soon assumes the suppurative state ot inflammation ; pus is form- ed, granulations shoot up m different parts, unite imperceptibly with one another, receive a thin pel- licle as a covering ; and thus the part is healed Besides the effects above-mentioned, vesicatories of cantharides often produce the more usually mark- ed consequences ot their internal administration* such as stranguary, &c„ II. Phenomena that succeed the admission of Can- tharides into the System. The pulse is strengthened, the appetite is im- proved* the mind is rendered more cheerful, the DD4 424 matter of the discharge from any diseased surface becomes opaque, is inspissated, and assumes the appearance of pus. At this time, a greater or less degree of pain ge- nerally affects the parts whence the discharge pro- ceeds. This goes off, if the medicine be omitted, increases if it continues to be taken, and is kept up, if the dose be only diminished. In the meantime, the discharge varies in quanti- ty ; but, on the whole, diminishes daily, and at last disappears ; leaving the parts sound, and capable of performing all their functions. Sometimes, on taking the first doses of the can- tharides, the discharge is increased in quantity ; but in general it is diminished ; and the matter general- ly evinces inspissation before the inflammatory sensations disturb the patient. The attack of pain will be at very different times in different persons, after they begin to them take the cantharides, though they individually take them in the same ratio. The quantity that some can take in a given time, without any sensible effect, is astonishingly great, compared with the smallness of the quantity which affects others. A perusal of the cases previously detailed will shew this. III. Action of Cantharides on the Urinary Organs. It is generally believed, that cantharides exert a sort of specific power on the urinary organs, parti- cularly the bladder and urethra ; and this opinion seems authorised by the fact, that pain in these parts, and stranguary, often speedily, and, if their use is continued, always sooner or later supervene during their admission into the habit. On more minute inquiry, however, we shall be satisfied, that this is only a concomitant effect; for in many instances 425 the pain and uneasiness are first felt in other parts, as in the uterus ; ulcers are brought to an active state of inflammation on almost any part of the body, before the affection of the urinary organs makes its attack ; and often they are altogether cured, without its causing any interruption in the administration of the remedy ; to this let us add, the effects on the general system, and the facts ascer- tained by Forsten, that the stomach, bowels, blad- der, &c were contracted at the sametime, we shall be convinced, that the opinion of this substance acting specifically on the bladder, is erroneous. It is worthy of remark, that, in Forsten’s experiments, the bladder, urethra, and even glans, were inflam- ed, while the kidneys and ureters seemed unhurt. h How does this correspond with the doctrine, that the active part of the substance of cantharides is absorbed into the mass of blood, and thence sepa- rated afterwards along with the urine in the kid- neys ? In short, we have ample proof, that they neither act specifically on the bladder, nor on the urinary organs in general : and that the kidneys and ureters are not affected in the same degree with the blad- der and urethra. In whatever way, then, we may attempt to explain the particular effects which they readily evince in the organs of urine and genera- tion, we can have no doubt, that these effects are only circumstances attendant on their general ope- ration. 426 IV. Effects of Cantharides on the General System . In investigating the nature of any remedy, we must consider its effects on the system in general, on the mind, and on the circulations. We must consider whether it chiefly affects par- ticular organs and functions ; how far these effects are modified by certain affections, either local or ge- neral ; and in what diseases it is chiefly beneficial. To know its comparative merits, we must consi- der what other remedies or means produce similar effects ; whether in kind or degree ; for the changes induced in the system, alter any substance has been received into it, indicate the medical properties of the substance ; and the degree of such change indi- cates the power of the substance considered as the cause. As is shewn then, in this work, the cantharides, when first taken internally in moderate doses, en- livens the f unctions of mind and body ; increases the celerity and force of the circulations ; improves the appetite, and increases the flow of urine and perspira- tion. Nor are their effects lessened by using them for any length of time, for I myself have frequently given them from a-year to about 1 8 months, at the expira- tion of which the patients had the same stimulant effects produced as at first, by perhaps one-twentieth part of the medicine, and were stouter than they had been for many years before Nor did they re- lapse into their former debilitated state on entirely leaving off the medicine. Yet Mr J. Hunter formed the most erroneous notion respecting the power of cantharides. * “ I think,” says he, t£ I have been able to as- certain this fact, that when the balsams, turpentines, or cantharides, are of service, they are almost im- mediately so ; therefore, if upon trial they are not * Hunter, p. 103. 427 found to lessen or totally remove the gleet in five or six days, I have never continued them longer.” But. on a comparison of cases, we shall find, that they effect a cure often in less than five or six days, but more frequently require many weeks, and even months, before they produce an effect. Mr Hunter had found them sometimes suddenly and unexpectedly useful ; and when they did not evince their power with equal celerity, he drew the impatient conclusion, that when they were not spee- dily successful, they were useless ! * 66 Balsams, turpentines, and cantharides,” ac- cording to another author, “ appear to be very per- nicious. During their exhibition, the discharge ap- parently stops. This is owing to the diuretic quality of the medium by which the mucus is continually wash - ed off, not any suppression of the discharge from any supposed specific power of these medicines on the uri- nary canal ! /” This is not the first instance on the records of our art, where a man attempts to explain that, of the nature of which he is ignorant, and which he has not patience to investi gate. V. Modus Operandi of Cantharides . In the facts and observations which I have ad- duced, it is evident that cantharides stimulate the functions of the system in general ; that the more evident changes, as evinced by either local or gene- ral phenomena, are of an inflammatory nature; that the diseases in which they are chiefly beneficial, are those accompanied with debility. As to the comparative merits of this substance, it appears that the other remedies which are found useful in the same complaints in which the can- tharides are successfully employed, are all of the to- * Wilkinson on Gleets, ch. ii. p. 9. 428 Tire or stimulant kind, and such as promote the ac- tivity of the vital and animal functions.. But all the other means have failed, when this last substance has proved completely successful. We have satisfactory evidence of this in the cases of seminal emission, gleet, leucorrhoea, &c. above re- lated, but in none more evidently than in those of obstinate ulcers; in which, after every other tonic and stimulant medicine had been employed in vain to co-operate with the external applications, the cantharides were prescribed, and then the sores as- sumed a healthy appearance, requiring no other dress- ing but simple cerate, and thus the cure was com- pleted. Thus, whether we consider the effects of cantha- rides on the general system, when taken internally, applied externally, or in comparison with other re- medies of a similar nature, we have irresistible tes- timony, that they operate powerfully on the whole system, inducing a degree of inflammatory action, which we are not able to command and maintain by any other means with which we have yet become ac- quainted. Indeed, they are perhaps the strongest stimulant we possess, while they neither have the heating nor intoxicating quality ot wine or ardent spirits. Cantharides then excite and maintain a certain degree of activity in the previously debilitated sys- tem ; they produce and maintain that degree of ac- tion during which debilitated organs are enabled to perform their natural functions, or return to their sound state ; and during which also suppurative in- flammation renovates the disorganized parts. On this principle we can easily perceive, why they have been found very useful in cases of great debility, either local or general ; and why they should be equally beneficial in inveterate sores on any part of the body. It has long been a great desideratum in the re- 429 sources of our art, to have means by which we could induce and support such an action in the system as would correspond with that during which certain parts are regenerated, diseased surfaces healed, and their healthful functions restored ; but we have it in our power to accomplish this important object by means of the properly regulated administration of cantharides. VI. Rules for the administration of Cantharides. TUe administration of cantharides is to be begun in small doses, which are to be gradually increased. In the meantime, we must carefully watch the changes, which proceed with such uniformity, that, if our instructions be obeyed, it is our own fault if ever the patient be surprised by untoward symp- toms. 1st, Twenty drops of the tincture, (prepared ac- cording to the London pharmacopeia) ought to be taken in a glass of water thrice a-day, and each addi- tional dose to be increased by two drops, till some de- gree of uneasiness be felt in passing water, when the doses must again be diminished ; or, if the sensation be severe, the medicine must be entirely left off, till this sensation abates, when it is again to be had recourse to, in doses sufficiently great, similarly to affect the system. This may be known by the in- creased force and frequency of the pulse, as well as by the symptom above alluded to. If the difficul- ty in passing water become suddenly troublesome, cloths dipt in warm water, or I rather prefer a large piece of sponge, dipt in warm water, and ap- plied to the belly, and between the thighs, will as- sist in relieving it. At such a time, also, a smart dose of any kind of purgative medicine may be taken. 2dly, If pain, or even uneasiness at stomach, be produced by the tincture, which in some patients is 430 hot uncommon, a small tea cup-ful of an infusion of chamomile flowers, or an infusion or decoction of any of the common stomachic bitters, such as co- lumba, gentian, &c. taken along with each dose, will relieve it. 3dly, If the appetite be umimpaired, nourishing soups, plain roast or boiled meat, fowl or fish, with vegetables, simply dressed, are the most proper kind of food, with one, two, or more glasses of wine af- ter dinner. In some states of great debility, 1 have found necessary, even for a time, to give about a pint of wine after dinner, and the same before going to bed. For common drink I should recommend soda-water, or, if preferred, simple toast and water. 4thly, No degree of cold, if the air be dry, can do the slightest harm. Cold lavation, or even cold bathing, may, if in other respects agreeable, be used with the greatest advantage. Moderate exercise on foot, or in a carriage, but by no means on horse- back, is extremely proper ; but when the effect of the tincture has become troublesome, it will be ne- cessary to refrain from every species of exercise, and to recline much on a sofa. The matter of the discharge becomes gradually thick and opaque ; this shews us, that the inflamma- tory action is begun ; and now we must not conti- nue to augment the doses ; but if, as sometimes hap- pens, this appearance remains stationary, or even goes off, when the dose is not increased, then it must be increased, but very cautiously. At length, an uneasy sensation is felt about the pubes, uneasiness, or even pain in the urethra, sometimes ardor urinae, and repeated inclination to pass urine, and the dis- charge has the form of laudable pus At this time the doses are not to be augmented, but are to be diminished or stopt, just as the disa- greeable sensations increase in severity. 431 After the use of the cantharides is left off, if the inflammation shall abate, and the discharge become more thin, the use of that medicine is to be resum- ed, and regulated as formerly ; but if the discharge gradually goes off along with the inflammatory ac- tion, the medicine is not to be repeated, for the cure will be effected without farther assistance. Very large doses of this medicine, sufficient to ex- cite the urinary organs into violent action, seem quite unnecessary for the cure of any disease, and scarcely ever occur, except by mistake of the pa- tient, or from his too great anxiety to get rapidly well. But it is a very pleasant reflection, that, independent- ly of the very greatest degree of action into which these parts can be put by such over doses, no in- convenience or after distress to the patient was ever, under my observation, occasioned by it. ' he story, so prevalent then, of irritation of the bladder, or of the neighbouring parts, from the violent, or even as has sometimes been talked of, from the slightest ef- fect of the cantharides, is ridiculous. I myself have never seen it, and I believe it to be only a conveni- ent excuse for those who start doubts from ill na- ture, and endeavour to maintain them by false- hood. Persons predisposed to glandular swellings, can- not use the cantharides but with the utmost cau- tion ; and where the glands are indolent, and of pre- ternatural size, it would be very unsafe to prescribe this medicine, as inflammation and suppuration of these organs would be an almost infallible conse- quence. To those affected with pain of chest, hard, dry, or teazing cough, in short, with symptoms of tubercles in the lungs, or of incipient phthisis, the cantharides must not be administered Regulated thus, we ensure its salutary efficacy, without incurring the risk of those pernicious effects 432 which attend daring ignorance, or equally culpable imprudence. I have, in various cases, since the publication of my first work on that subject, employed the cantha- rides in substance. I have f~und it in every res- pect equally beneficial and equally safe as the tinc- ture. In some, however, it creates pain in the sto- mach, when the tincture can in the same patients be taken with impunity. But in no other circumstance does it seem injurious. The form I use it in is that of pills, each contain- ing one-fourth of a grain of the powdered fly. VII. Means by which the bad Effects of Cantharides are a leviated or removed. If, from inattention, either on the part of the pa- tient, or medical attendant, or from any unforeseen circumstance, there should supervene strangury, or or even complete suppression of urine, great pain in the organs of urine and generation, sickness, vomit- ing, headach, rapid and strong pulse, &c. warm fo- mentations are to be applied over the pubes, and smart saline cathartics are to be exhibited, with di- luents. In my own practice, smart cathartics, with these fomentations, have always been sufficient to allevi- ate the immediate pressure of distress ; but, no doubt, the degree of the antiphlogistic treatment must be proportioned to the exigencies of the situa- tion. Dr Greenfield maintains, that camphor most pow- erfully corrects the effects of the cantharides. But this remains to be proved He exhibited them together, and others since have followed his example It appears from the experim nts of Dr Forsten on dogs, that camphor taken with cantharides, cer- tainly very much diminishes the activity of the lat- 433 ter.* Half a dram of the powder of cantharides produ- ced death ; f but, the same quantity, given along with one scruple of camphor, produced only slight mor- bid symptoms, from which the animal completely recovered. J When the same dose was given with only g r . xij of the camphor, the dog suffered much more severely ; he refused food three days, but at last recovered perfectly. § Even g. viij. of cam- phor seemed to prevent the powdered canthari- des from killing the animal ; though, % in another instance, the same dose of both proved fatal. || Olive- oil and opium also diminish the activity of the can- tharides. But I do not perceive the utility of giving these substances along with the cantharides, since it is pro* bable that a small dose without, is equal to a greater dose with any of them. Before we could consider these substances as an- tidotes to the cantharides, the experiment must be made in another way ; the cantharides must first be allowed to produce the morbid or dangerous symp- toms, and then we must try if the camphor, &c. will relieve or remove them. VIII. Conclusion . The medical properties, which I have assigned to the cantharides, are by no means consonant to the general opinions which now prevail, nor are they an- ticipated on any solid principles, so far as I have been able to ascertain in the works of the medical authors of former times. * Exp. 7 th and 11 th , p. 71 and 7S. f Exp. 20 th , p. 78. t Exp. 21 st , p. 79. § Exp. 22 d , and 25 th , p. 79 and 31, ! Exp. 23 d , p. 80. || P. 87. e e 434 For, though the internal use of the cantharides, in several diseases, is as ancient as the history of me- dicine, yet there has always prevailed great diversity of opinion with regard to the consequences of their admission into the animal system. There is the most positive evidence on record, that cantharides have been singularly useful in many very desperate instances ; but certainly they have often been followed by very alarming and de- structive effects. How, then, are we to decide with regard to their merits as an article of the materia medica ? If their effects were uniformly salutary, there could be no dispute about their utility, but there is no remedy of this description. If their effects were uniformly bad, their use ought to be abandoned; but they have at one time proved very salutary, at ano- ther very noxious. I have therefore deemed it my duty more carefully and scrupulously to observe those circumstances in which either event had suc- ceeded their administration, in order to know when they might be prescribed with safety, and with well founded hopes of advantage. Cantharides are proved to be a very active stimu- lus ; and all the complaints in which they have been unequivocally and certainly useful, are those of de- bility or the atonic. If the administration be too long continued, and the doses too great, or if they are administered during the prevalence of the phlogistic diathesis, bad conse- quences are to be expected : and such is the source of the different opinions, or rather mistaken notions entertained by authors with regard to this medicine. Some have happened to employ cantharides op- portunely, with the very best effects ; and others un- seasonably, and of course unfortunately. No won. der, then, that they have been both extolled and de- graded ; but had medical men carefully compared the dissimilar circumstances of the cases in which 4 35 they employer] them, the reasons of success or of failure would have unveiled themselves. Nature is correct and regular in her operations, and there is no such thing as chance : renew pre- cisely the same causes and circumstances, and the event will be invariably and precisely the same. Inattention to this mode of procedure has alone, I repeat, occasioned that diversity of opinion which prevailed with regard to the effects of the cantha- rides ; and this inattention, combined with the dread of danger, has almost banished them from practice as an internal remedy. I flatter myself, however, that I have not endea- voured in vain to refute the errors which obstructed the very great advantages to be derived from the can- tharides used internally ; and have assisted in vindi- cating the rank they should hold among the most valuable resources of the healing art. It is now many years since I first began my re- searches respecting the nature of this substance, and its efficacy in the cure of diseases. My first attempts in the way of publication on the subject were on a contracted enough scale. But I am happy to find, that the principles even then announced, contained no erroneous or hurtful doctrine. The faults alone lay in my having too contracted a notion of the pow- ers of that valuable medicine. Since that period, I have in part removed that objection, having pro- ceeded somewhat further in my enquiries. Even yet, I am far from believing that I have ascertained nearly the effects of that medicine ; but I hope I shall, by patient perseverance, still farther develope their powers. If, however, I am deprived of this, I hope the specimen I have given the world will, in- dependently of party spirit, or any similar bar to the advancement of every valuable fact, follow out these researches that the full powers of such an active me- dicine may be known. Thus, and by similar inves- E e 2 436 ligations, we would soon banish from our pharmaco- peias that miscellaneous assemblage of drugs which can never be of use but to him who wishes to cover his mistakes and blunders in a multiplicity of at best unmeaning substances ; who can shield himself from detection where mystery prevails, but who would be afraid to proceed on the principles of simplicity and truth, and whose chief occupation is to depre- cate improvement. Throughout the present work I have adhered strictly to the bare statement of facts. Perhaps on that account, deprived of the flourishes of eloquence, it may to some appear defective. But I have long been of opinion, with Mr Horne Tooke, that £ ‘ truth needs no ornament ; and, in my opinion, what she borrows of the pencil is deformity If my labours, then, or my researches, shall in any degree contribute to the alleviation of that wretch- edness which either the diseases I have treated of, or the wrong treatment of them occasion, I shall be amply rewarded. EXPLANATION OF THE PLATES PLATE I. Fig. I. This figure represents a front view of the urinary and genital parts belonging to a man : where each part is (as much as possible) preserved in its proper situation. A. The descending trunk of the aorta, or great artery. B. The division of this trunk, where it sends branches to the under extremities. C. The two kidneys \ of which the right is somewhat lower than the left D. The ascending trunk of the vena cava. E. The emulgent veins and arteries. F. The spermatic arteries and veins 5 which take their rise from the aorta, and the vena cava and emulgent vessels, and run along interwoven with each other to the testicles. G. The ureters ^ descending from the kidneys to the blad- der. H. The vasa deferentia \ which carry the semen from the testicles to the vesiculae semina- les. I. The testicles. K The bladder of urine. L. The neck of the bladder } which is muscular, and forms the sphincter : by means of which the urine is retained. M. The elevating muscle of the penis 5 whereby it is fasten- ed to the os-pubis : and which contracts the venae penis, so that the blood must swell up the ca- vernous body of the penis } and thus become erect. N. O. '1 he musculi directo- rs penis ; these are the lateral muscles, which contribute als» to the erection. P. The penis. Q. The glans. K. The inguinal glands. S. Part of the intestinum rec- tum. Fig. II. The inside of a kidney. A. The body of the glandu- lous substance of a kidney 5 where the urine is formed. B. The emulgent artery. C. The emulgent vein. D. The bason 5 into which the various ducts pour the urine from the kidney, as it is formed. E. The ureter $ which car- ries the urine to the bladder. Fig. III. The scrotum } and the manner the testicles are contained in it. A The testicles. B. The^ spermatic vessels, and vasa deferentia. 438 C. The peritonaeum 5 which continues from the abdomen, in closing both testicles, though se- parately, in the scrotum. D. The scrotum E. The septum which divides the scrotum ; and helps to sus- pend it. Fig. IV. The inside of a testicle. A. The glandulous substance of the testicle. B. The skin which covers it. C. The spermatic vessels. D. The vasa deferentia. EXPLANATION of PLATE II. Fig. I. This figure represents the membrum virile in its natural position, viewed side- ways $ in order to exhibit the curve of the urethra, as well when the mem- ber is erect, as when it is flac id. A The bladder. B. Part of the intestinum rectum C The anus. D. The neck of the bladder. E. The urethra j this part from O to C is called the peri- naeum, F. The conjunction of the os pubis. G. The connexion of the erectores, &c. H The pubis. L. The abdomen M. I he penis when erect. N. The glans. O. The penis when flaccid. P. The scrotum. Q. J'he testicle. K. The spermatic vessels. S. The vas deferens. T. The ureter. U. The vesiculae seminales. Fig. II. Representing that part of the | urethra which is next to the rectum. A. A portion of the blad- der. B. The ureters. C. The vasa deferentia. D. The vesiculae seminales. E. The prostate gland. F. Part of the urethra. G. The blood-vessels of the vesiculae seminales. H. The mucous glands. I. Two small glands near the prostate. K. The accelerator j divided in the middle, and expanded. L. I'he bulb of the caver- nous body of the urethra, infla- ted, and divested of the accele- rator muscle. M. The third pair of mus- cles of th e penis. N. The musculi directores penis. Fig. III. The cavernous body of the urethra, with the glans, slit open, so as to see it partly in- side. A. The cavernous body. 439 B. The urethra. C. The cavity formed in the corpus cavernosum glandis pe- nis \ in which the extremities of the corpus cavernosa penis are received. D. The upper part of the glans. E. The glans. F. The frasnum. EXPLANATION AAA. External surface of the bladder, * B. The part of the blad- der into which we strike the trocar in perforating it from the rectum. C. The prostate gland. D. The vesiculae seminales. E. The vasa deferentia running into the vesiculae. F. The ureters which en- ter the bladder about an inch behind the vesiculae and toward the side of them. G. The membranous part of th-j urethra. HH. The cavernous bodies ; where they rise from the arch of the pubis. Fig. IV. Shews the situation of the in- guinal glands, and the neigh- bouring parts. A. The glands. B. The testicle. C. The sartorius. D The rectus femoris. E. The triceps. of PLATE III. I. These two bodies unite, and form the body of the penis. K. The pendulous part of the bulb of the urefhra 5 this bulbous portion occupies all the perineum, and is covered by the accelerator urinse muscle. L The bulbous part of the urethra, and the accelerator uri- nae muscle cease here. But the cellular body (distinct from the corpora cavernosa penis) accom- panies the urethra the whole way, till, at the point of the u- rethra, it is dilated to form the glans penis. M. The glans. N. The fasciae of the penis. EXPLANATION OF PLATE IV. Fig. I. I The forepart of a human pe- j nis prepared 5 so as to exhibit it in the state in which it is when it is erect. A. Part of the sphincter ani. B. The trail versales. C. The arteries of the penis. D. The musculi erectores. These muscles are spread, in or- der to exhibit them more dis- tinctly. E. The vena penis. F. The corpora cavernosa. G. The skin separated from the penis. g. The lymphatic vessels. H. The nerves of the penis. I. That part of the skin which composes the praepuce. Fig. II. A. Part of the penis, B. The duplicature. 440 C. Gians. D. The crown. Fig. III. The back part of the penis j prepared as before. A. Part of the sphincter ani. B. The musculi transversales penis. C. The directores, or erecto- res. D. The corpora cavernosa penis . E. The corpus cavernosum urethrae F. The fraenum. G. The glans. H. The arteries. I. The nerves. K. The bulb, covered with the musculus accelerator. Fig. IV. The fore- part of the urethra laid open to shew the orifices of the excretory ducts of the mucous glands ‘ y and the openings of the ureters, and from the vesiculae seminales. A. Part of the bladder. BB. The openings from the ureters. C. The caruncle, or caput gallinaginis j with the mouth of the excretory ducts of the pros- tates. D. The openings of the mucous glands. E. Parts of the seminal ves- sels. F. The vasa deferentia. G. The mucous glands. H. The bulb of the caver- nous body of the urethra. Fig. V. The vesiculae seminales, and vasa deferentia inflated, to shew its natural form and cavities. A. The inward cavities of the vesicle. B. The external form . C. The vas deferens left whole. D. The common orifice. E. The vas deferens cut through. Fig. VI. A longitudinal dissection of the penis, in order to shew the in- ternal part of the cavernous bo- dy and the septum. A. The corpora cavernosa penis. B . The septum. • C. The capsula or mem- brane. D. The corpus cavernosum glandis penis. Fig. VII. A transverse section of the penis. A. The trunk of the vena penis. B. The Urethra, and its cor- pus cavernosum. C. The corpora cavernosa penis. D. The trunk of the arte- ries. E. The tegument of the corpus . F. The capsula, or common tegument. EXPLANATION of PLATE V. A. Os pubis, B. Os sacrum, C. Bladder. D. Ureter. E. Rectum. F. Levator ani. 441 G. Anus, H. Spermatic vessels. I. Testis. K. Vas deferens. X.. Vesiculse seminales. M. Their termination. N. Prostate gland, O. Membranous part of the urethra* P. One of Cowper’s glands. Q. Corpus cavernosum cut across. R. CJrethra, with its corpus spongiosum cut. S. Vena Magna. T Crus penis cut across, U. Catheter in the urethra. EXPLANATION of PLATE VI. A. The external surface of the flaccid bladder. B. The folds into which the bladder falls in this flaccid state. C. The eminence which the prostate gland makes within the bladder. D. The cut substance of the prostate gland. E. E. The caput galinaginis, and openings of the seminal ducts. F. F. Enlargedlacunae,whicht in their healthy state secrete mu- cus to lubricate the urethra, and pour out the discharge in gonor- rhoea. G. One of these lacunae un- commonly large, into which the point of a bougie may enter. EXPLANATION of PLATE VII. Represents a stricture at the bulb of the urethra, where the sides of the urethra had ap- proached each other nearly in a point, and where the stricture is so narrow, as just to allow a bristle to pass through it. A. A. The posterior surface of the bladder, which is contract- ed and thickened in its coats. B. B, The two ureters near their insertion. C. C. The two vesiculae se minales, with the vasa deferen- tia, not very accuraiely dissect ed. D. D. The prostate gland somewhat enlarged in its size E. The urethra at the mem- branous part laid open, and sound in its structure. A quill has been put into it, leading on to the bladder. F. The urethra near the ex- terior extremity of the penis, in a healthy state. G. The stricture at the bulb of the urethra, so narrow as just to allow a bristle to pass through it. FI. H. A part of the crura of the corpora cavernosa. EXPLANATION of PLATE VIII. Represents two strictures in in two inches of the orifice of the urethra. The one is near the urethra the bulb, and the other is with- A. A. A small portion of Ff 442 tlie Madder, a little tliickn ed in its oats, with the insertion of the ureters very observable. B B The two sides of the prosta e gland in a sound state . C C. The crura of the cor pora cavernosa penis divided, 1> D The corpora caver no'.a themselves divided E E. The glans penis also divided. F The anterior stricture, which is of short extent, but the Inner membrane of the urethra is a little irregular and thick- ened. G, The stricture near the bulb, which is nearly an inch in length ; the rest of the ureth- ra is in a healthy state. A. A. The urethra of its na- tural width. B. The stricture. C. C Part of the corpora ca- vernosa. EXPLANATION of PLATE IX. The urethra opened in two dif- ferent places, one before the stric- ture, the other behind j the one before is through the body of the penis \ the other behind, is upon the anterior surface of the mem braneous part, and a bougie passes from the one pening to the other. A. A The crura penis and bulbous part of the urethra all blended together by inflamma tion and suppuration, which has tak n place in many parts. B B. The prostate gland in a diseased state. C. C. The cut edges of the bladder. D. The urethra behind the stricture very much enlarged, irregular on the surface in con- sequence of ulceration. E E. 1'he cut surface of the corpus cavernosum penis. F. F The cut surface of the corpus spongiosum urethra. G. G. l'he bougie passing from the sound to the unsound part of the urethra. H. A small bougie in the new passage. EXPLANATION of PLATE X. Represents an ulcer in the membranous part of the urethra. It is of considerable extent, and bad destroyed noi only the coats of he urethra, but the integuments at this part. A. A. A portion of the blad- dei considerably thickened, with the fasciculi of its muscular fibres strongly marked, B. B. The cavity of th prostate gland, enlarged from distention in consequence the accumulation of the urine be- hind the ulcer. The ducts of :he prostate gland may be seen very much enlarged from the Sr-me cause. C. The ulcer in the mem- branous part of the urethra. D. A narrow part of the urethra, immediately before the ulcer, which had been a part of the stricture destroyed by the process of ulceration. E. E. A part of the corpora cavernosa. 443 EXPLANATION or PLATE IX. Represents a fistula in peri- nseo. A. A section of the bladder very much thickened in its coats. B. A section of the prostate gland, which from the thicken- ed state of the bladder, is very obscurely marked. C. t he cavity of the pros- tate gland, and of the membra- nous part of the urethra, D. A fistulous orifice leading to a long fistulous canal. E. Another orifice, or rather short duct, communicating with the same canal. F. F. the fistulous canal it- self, in which there is a long slender bristle leading from the orifice. D. It has one of its termina- tions in the scrotum. G. Another termination of the fistulous canal in the peri- naeum. H. The stricture in the urethra, through which a bristle is passed. I. The remaining part of the urethra. K. A part of the corpora ca- vernosa. L. The scrotum somewhat corrugated. EXPLANATION of PLATE XII. Fig. I. Represents a side view of the genital parts peculiar to the female. A. The bladder. B. The vagina. C. The uterus. D. Part of the fallopian tube. E. Part of the rectum. F. Mons veneris, K.G. N. Pudendum muliebre. K. N. The rima magna. G. The labiae. H. The Nymphae I. The clitoris. K. The praepuce of the cli- toris, L. The meatus urinarius. M . The orifice ot the vagina. N. The pcrinaeum-, the space between the pudendum, and the anu^. O. The anus. P. The ureters. R. The carunculae myrti- formes. Fig. II. This figure represents the ute- rus and vagina j partly opened. A. The uterus j that part next the rectum. B The inside of the vagina j with the rugae, and the small openings of the mucous glands, called Lacunae. C. The mouth of the uterus. D. The orifice of the meatus urinarius E. The carunculae myrti- formes. E. The praepuce of the cli- toris. F The clitoris. G. The external part of the vagina, H. The falopian tub^s. i. The external parts of the ovaria. 444 K. The ovaria freed from the skin. L. The spermatic vessels. M. The loose flaps of the tubes, called the morsus diaboli. N. The broad ligaments j properly nothing but a coatinu- ation of the peritonaeum. O. The ureters. P. The ligamenta rotunda. Q. Its extremities 5 which are fixed at the os pubis, and where its ramifications end in the cli- toris. R. Some of the blood ves- sels , which from the spermatic vessels, give their branches to the fallopian tubes, and the uterus. Fig. III. The clitoris, and its appen- dages \ inflated, as it is in coitu. A. The body of the clitoris j distended, as it is with blood in coitu. B. The great vein, C. The arteries and nerves. D. The extremity of the cor- pora cavernosa of the crura 5 cut from the ossa pubis. E. The musculi erectores cli- toridis, freed from the ossa cox- endicis, and left at their termi- minations. F. The crura also distended. G. The corpus cavernosum pudendi, inflated by the veins of the clitoris. FINIS. Printed by John Moiry Edinburgh . Hate l . Pub. Peir!6*im. by LI. St* tkdtO* 41. Pall MaM Plate H . Tub Bleb'S *J81I k/JlSto,-UoJy.41.P/UL MoU. PlafeEI Pub?rc6?6*l8U by IT. Stockdak 41 £aM Mali. » Plate fub*£cb: 6* t8Ub.y IT.StcckdaU. Mali , . . -Ji * ; r +• ' ^ * Plate V. Plate VL rub?FeAS6?‘J3U byTL S bo ckdaU AlFaJIMiU. Plate VH -Pub?fd>?6‘!‘J/)lt iy ll Stackdalc 41 Pall Ml all Plate V'llI r Ob 1 Feb f 6”‘1UU. bj’ 1L S tockdajkM- FaJJ.JHnH. Plate TX Pub *Feb J . 6 *1811 by II StodUaU dJ Ball MaU . Plate X . Tui^Fei'6^181J. by II. Stockdalc. 4± Fall Mall. I PI ate XL. Pub d Fe/>* 6 ^ i#M. 6y J.T.Stockda.le,.41-I > < 1 'tt^ a M / - Plate XI I 11 ell 6^1811. by 1.1. S to dedal » 411aU Mall-.