On diseases of the generative system : illustrated with 12 plates

Front matter

THE

ABNER WELLBORN CALHOUN

MEDICAL LIBRARY

CHAP. I. Pathology of the Urinary Organs

Suppression, Retention, and Incontinence of Urine 19

CHAP. IT.

Pathology of the Male Organs of Generation.

Seminal Emission . , 22

Disease of Prostrate Gland 7 33

Gleet J

Spasmodic Stricture 4<>

Permanent Stricture 50

Fistula in Perincea 57

CHAP IV. Treatment common to loth Sexes

Gonorrhoea 280

Lues Venerea 303

APPENDIX I.

Critical Examination of Mr Home's Works on Stricture in the Urethra, ac 360

APPENDIX II.

Ulcers, Eruptions, &c 3S9

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 jimhricated read fimbriated. CO 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 two 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 wore read most.

268 10 read 'with her rapidly encreasing, &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 preventives.

311 6 from the bottom, for pressure teadprepuce.

318 7 for disposition read disposed.

332 1 from the bottom, for either read whether.

352 12 from the bottom, insert the mouth after as<&

424 19 dele them.

Introduction

-Ill otwithstanding 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 neglected. The practice adopted in them has consequently 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 erroneously 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 approaching to absurdity, and demonstrate, at a single glance, the ignorance of their authors respecting those laws of the animal economy, with which every one ought to be well acquainted, before he attempts to prescribe for any important disease.

In following many of the rules of these writers, and in attempting to imitate their too often confused and improbable statements, disappointment, such as frequently happened with myself, must have been experienced by others in a variety 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 exercising 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 sometime 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, whereever the liberal and candid have patiently followed the mode of cure pointed out by me, they vessels of the uterus ; and if such debility and dilatation 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 muciparous glands- And when it is known, from actual observation, that not only the uterus becomes weak, spongy, and flaccid, towards the approach of menstruation, but that the whole system is sensibly enfeebled ; we shall not be surprised, that about this time the mucous discharge should be augmented. Accordingly, we can easily perceive how the leucorrhoeal 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 differeht origin. That which may cause the apparent increase of the leucorrhceal discharge, shortly before and after the flow of the menses, is, the circumstance that, even in health, the menstrual flux is both preceded and followed by a serous discharge, which, mixing with that of leucorrhosa, 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 leucorrhceal discharge is aggravated at any time between the menstrual periods, and consequently independent of them, by passions of the mind, by hysteric attacks, by fatigue, &c. ; and that the disease happens even before puberty, when the vessels neither doj nor ought to pour out the menses.

The 3d argument, " From the flow of the menses being diminished, in proportion as the leucorrhoea 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 generally be considered as immoderate, which is preceded and followed by leucorrhcea j ' and it is even

E 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 considerable degree of menorrhagia, producing very remarkable effects ;" and, it is a fact that, in proportion as the leucorrhoea is removed, the menses return to their wonted limits, both as to time and quantity.

Though leucorrhoea even continued after menstruation, 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 apparent consentaniety of both, might be owing to the periodical return of that delibity which is absolutely necessary to the existence of both.

That there may be an increased discharge of serum 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 precedes 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 probable, that those leucorrhoeas, if they may be so termed, 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 vessels ; it only shews, that the two complaints affect

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the general constitution in a similar way. Many other diseases, very different from one another, produce nearly the same effects on the general system, and, in this respect, menorrhagia and amenorrhoea agree.

That the discharge is not preceded nor accompanied with symptons of any topical affection of the uterus, shews, that the disease comes on sometimes 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 discharge 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. 4

But there are many facts which shew, that the leucorrhceal 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 opportunities 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 uterine system ; and this is corroborated by the fact, that this disturbance is not perceptible, till the disease is far advanced, which would certainly sooner manifest itself, if the vessels, whence flow the menses, were primarily and chiefly concerned. That E2 it is hot confined to the uterus, is decidedly proved by this, that, after pregnancy, when the mouth of the uterus is shut, the leucorrhoeal discharge is often more copious than before conception

The celebrated Hoffman, * to whom Dr Cullen acknowledged himself much indebted, very concisely 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 returns 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 menstruation, are not exempt from it ; and it is present during the whole time of gestation "

Now this discharge is often so acrid, as to excoriate the pudenda and thighs ; and what dreadful 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 vagina from the action of such a discharge.

In addition to these general reasons, we have the demonstrative evidence of dissection and actual observation, 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 : wherefore it bahnot» in such instances^ be produced by the same vessels which in their natural state pour

out the menses. If to this we add, that the purely serous discharge is not established, by one well ascertained 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 by no means the affection generally called leucorrhcea.

I know that attempts have been made to reconcile 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 clo?ed, the serum flows. * But this is so absurd an explanation, that it requires no refutation. This reasoning is somewhat anajagous to that, which -more lately suggested an absurd enough practice for the cure of amenorrhcea, 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 Fothergill ! f

In Puncan's Commentaries, there is a case related, which shews, that the leucorrhoeal discharge sometimes proceeds from the vagina alone, and that the catamenia proceed from the interior surface of the uterus.

A woman, who had long laboured under prolapsus uleri, 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 tng. vol. v. p. 180. E3 charge came through the os uteri, but the leucorrhoeal 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 leucorrhoea, will amply prove.

f He squeezed the white matter of fluor albus from different parts of the interior surface of the uterus.

% 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 appeared on its anterior surface, but none at the border of the os uteri. The vagina and hymen were inflamed, from the matter, no doubt, of the discharge.

|| 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 ancient and modern physicians reckoned these effects very similar to each other.

I have, however, no hesitation in stating the vagina 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 leucorrhoeal discharges proceed from the same vessels.

It is of importance to observe, that a great proportion of women have been taught to believe that Jeucorrhoea 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 experienced 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 Leucorrhoeal Discharge.

As it appears established, that the leucorrhoeal discharge 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 f discharge proceeds from the vagina alone, or from the uterus, or from both.

When there has been no disturbance in the functions 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.

f-

But if the disease have altogether another source, and proceed from the urinary organs, we may discover, by the functions of the bladder being disordered, by pain in passing water, the discharge being much increased in rising from a horizontal posture, the appearance of the urine, and the discharge 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 affections, 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 symptom, or comparatively insignificant addition to affections 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 under my observation, as illustrating these varieties, are worthy of notice.

A young girl, aged 16 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 affected with swelling of the labia pude?idit 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 cath.rtus 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 formerly.

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 inflammation of the labia pudendi, with great swelling, difficulty 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 mentioned 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. ,

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Causes.

There is not a power that can debilitate the human frame, but has been, and perhaps truly, reckoned 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

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74 . 4

in the mammae of nurses, which have been numbered among the causes, they seem scarcely worthy of notice.

The disease is denominated leucorrhcea, fluor albus, 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 complains 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 occasionally 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 J 10, 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 fearful dreams, and is far from refreshing.

The general health and external appearance suffer 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 certain softness, a sort of puffy swelling and bloated appearance over the whole body, in this respect resembling 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 x Qw *wf£ £ p d t4 Mm <£:

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*.

in different individuals, and at different times during the disease.

Her mind is very dejected, very apprehensive, very easily alarmed, and affected with deep melancholy, She is extremely peevish, fretful, irascible, and anxious.

She feels oppressed about the precordia, is troubled with slight cough, dyspnoea, and pain on full inspiration, with palpitation and fainting, particularly on the body being suddenly moved, or the mind in any way alarmed.

The affections of the stomach and intestinal canal are generally present during the whole course of this complaint ; these are want of appetite, depraved digestion ; in short, all the symptoms of dyspepsia, with sickness in the morning and evening, and vomiting.

The bowels, for the most part, are obstinately costive, but sometimes there is a severe dysenteric at- A tack, succeeding the constipation.

The urine is turbid, and the bladder is often much affected.

The menstrual discharge is frequently too copious, irregular and discoloured ; sometimes scanty, or even suppressed, as shall subsequently be explained.

This last occurrence has been followed by very singular symptoms, for to the suppression of menses, we are assured that there often supervene haemoptysis, dysentery, hoematuria, 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. -frr^w.

The disease is sometimes cured spontaneously, by some change or revolution in the system, manifesting itself in critical evacuations, as copious salivation, diarrhoea, sweating, vomiting. / 1 -

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 accumulating 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, supervene, 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 common 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 lime, the function of generation is disturbed, and it is not an uncommon 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, sometimes intermitted ; varies in quantity at different 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 between 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 affects the state of the body.

The matter of the discharge assumes a great variety of appearances, according to the state of the parts from which it proceeds, and more or less, that of the general habil conjointly.

It is at one time clear, limpid, viscid, or glairy ; at another, white, grepn, yellow, brown, or of mixed 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, vagina, labia pudendi, and thighs.

In the discharg-e there sometimes appear, particularly in the last stage, fleshy tumours, detached coagulated substances, portions of membranes, the products of spacelation, and even animalcula resembling ascarides, are recorded to have been found in it. — £V>vor <xa <*£&

Sometimes the discharge stops spontaneously, and this is succeeded by very troublesome consequences, as pains in the hypogastric region, and head, fever and delirium ; ulcers break out on different parts, which relieve these symptoms ; and, not unfrequently, on such an occasion, acute, chronic, exanthemata, breakout over all the body. Erysipelatous, and other Options, however, are not rait at any time during the disease.

Dr Cullen's hypothesis implies, that the leucorrhceal is nothing else than the depraved menstrual discharge : . But this is not only very improbable, from the circumstances above mentioned, but from others ; the leucorrhceal 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 inflammation of the vagina, because, in these circumstances, they would consider it rather as gleet than leucorrhcea.

But between gleet, considered as a disease of debility, the principal symptom of which is a chronic, mild, glairy, or somewhat puriform discharge from the vagina, and leucorrhoea as an atonic complaint, there really is and can be no distinction, from whatever cause they may have originated ; the medical treatment of both must be precisely the same, and equally regulated by the same concomitant symptoms.

It will frequently happen, that we cannot determine whether the complaint has arisen from venereal 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 affections, pains in the loins, &c. ; has not been regular in her menses, either as ti^quantity, duration, or recurrence ; if the menses rave either been preceded or followed, for some time, by an usually great serous discharge ; and there has, to these symptoms, 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 the patient has suffered from abortions, tedious or difficult labours, or is at that age when the menstruation must cease, in obedience to an immutable law in the animal economy, we sh#ll be pretty safe in considering the complaint as a leucorrhcea.

But if a woman, enjoying good health, is suddenly attacked with ardor urinae, puriform discharge from the vagina, and other inflammatory symptoms, the suspicion of venereal infection will be very strong.

Still, however, let us hesitate before we pronounce an opinion ; we may stain the purity of innocence, and, to bodily sufferings, add those of the mind, from which the unfortunate individual may never recover rf- ^UJ

Though the suspicion be very strong, yet even this form of the disease may arise from many causes, totally independent both of infection or coition.

Inflammation of the most active kind, seizes the female organs of urine and generation, quite independently 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. X

Youno- 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 tumified, reddened, excoriated, and exquisitely sensible to the touch. Pus flows in great quantity ; the urine cannot be voided without excruciating torture; and the complaint is completely removeable by the common antiphlogistic means.