An inquiry into some of the effects of the venereal poison on the human body : with an occasional application of physiology, observations on some of the opinions of Mr. John Hunter and Mr. Benjamin Bell, and practical remarks

Preface

I

F we had no other motive for investigating disease, curiosity alone would be sufficient to invite us. But there are so many opinions upon all diseases which time has discovered, and will yet discover to be erroneous, and there is such a constant desire in the medical practitioner to benefit his patient, that perhaps no subject will be more frequently discussed than the causes and cure of the various maladies which afflict us. Of these, the most prevalent and distressing will be the oftenest considered, and, therefore, the venereal disease has been the subject of much medical reasoning And reflection.

That practice alone is worthy of the name of rationaly which is governed by physiological truths. If our means of cure be not directed by some knowledge ot the operation of causes, and the functions of the body, such practice deserves the name of empirical,

A 2 A phy-

IV PREFACE.

A physiological reasoner directing remedies, of the power of which he has already obtained some tolerable notions, can hardly tail to benefit individuals ; but if any one administers them at random, he may be right by a lucky chance, but it is more probable that he will do much mischief.

In applying remedies to gonorrhoea, the practitioner must be much governed by his opinions on its pathology. Whether he thinks with Mr. Hunter, that the matter of chancre and of gonorrhcea is the same, or with Mr. Bell, that they arc

caused by two distinct poisons his practice, if

at all consistent, will be much influenced by the opinion he espouses.

When it is clear that the com.plaint has a venereal cause, we give mercury to cure it : — But if v/e should be of opinion that its nature is not venereal, we should, of course, omit to use that remedy, and depend upon others. But what will be the practice, and what the embarassment of a practitioner, desirous of doing what is right, but not having sufficient experience of his own to decide his judgment ? He is agitated between those opinions, and cannot strictly follow the mode of cure which either suggests. Doubting whether he has chosen a wrong system, he changes his opinion and practice as often as he

per.

PREFACE. V

perceives an unfavourable variation in the symptoms.

If wc examine into the state of the opinions respecting this disease in a more advanced stage, namely, that of lues, the disagreement is as perplexing. The points of contention are not trivial ones, or matters of mere curiosity ; they are of the greatest practical importance. Whether the effects of the venereal poison, when in the blood, be venereal— whether the system has the power of soon getting rid of poison — whether the poison accumulates in the blood, &c. &c. These severally •need discussion. The importance of a right decision upon these questions cannot be doubted. According to the ideas we are impressed with upon these points, must our practice be regulated.

These, and such like contradictions and uncertainties, furnished the motive for publishing the following pages, and I hope sufficiently apologize for my adding to the number of works already circulated upon this disease.

In undertaking a work of this nature, it was necessary first of all to decide whether chancre and gonorrhoea were of the same nature. Because, from analogy and a just comparison of their different phaenomena, important inferences were to be drawn.

From our imperfect knowledge of the composition of the venereal poison — from the difficulty

A J and

VI ERE FA HE.

and ambiguity of chemical experiments capable of being made upon th-s matter, it appeared that the safest, easie t, and ahiiost only way to acquire this necessary information, was to see whether these two diseases ever produce each other, or if gonorrhoea e^^er produces that unequivocal effect of the venereal poison — lues. Because, if the poirsoiT of each be the same, we might reasonably expect that the one v/ould (sometimes at least) cause the other ; or that gonorrhoea would, in some instances, contaminate x^nt system, and produce lues %'-enerea.

To acquire this knowledge, two modes offered. First, by the experiments of inoculating with the matter. Secondly, by tracing the disease through the common course of communication. The latter, for many reasons, appeared infinitely more preferable.

To make experiments upon our fellow creatures, must be highly distressing, if we could obtain permission. 1 do not think the natural solicitude of a practitioner for the welfare of his patient, would permit him to follow up an attempt of this nature to a proper extent. We cannot measure the extent of such experiments! nor appreciate health !

To the individual we can never be justified! Besides, experiments of this nature arc not altogether free from error.

In

PREFACE. Vii

In tracing the course^ and observing the consequences of these diseases, I have been led to conckide that the poison of gonorrhoea and of chancre is the same. The circumstances on which I ground my opinion, occupy the first chapter of this work.

Having gained this information, I thought myself authorized to reason and apply it to the explanation of several of the ph^enomena attending clap, to answer some objections, and explain some of the important differences between the two effects of the same poison, gonorrhoea and chancre. I then thought it necessary to examine into the nature of the evidences which Mr. Bell brings forward to support a different opinion, and give a few practical hints upon the cure of clap, which the inferences suggest. These comprise a preparatory part.

Proceeding to the subject, namely, a physiological inquiry into ^ome of the singular effects of the venereal poison, it naturally divided itself into two distinct sections of inquiry: First, into the effects of the poison when externally applied, — Secondly, into the effects when circulating in the blood*

On the effects when externally applied, I have noticed the continuation and extension of the venereal disease. In these respects it is different from many other maladies. I have attempted a A 4 phy-

Vlil PREFACE,

physiological review of Mr. Huntcr*s opinion, which, together with some analogical reasoning, has occasioned me to draw an inference different from his, and I have added some observations which seem to strengthen that inference.

In considering Mr. Hunter's theory of the cause of the poisonous quality of venereal matter, some inconsistencies and contradictions struck me. I have endeavoured to investigate how far his opinion is capable of being applied, to explain different incidents of this disease connected with it, and whether it is in conformity to laws of the animal ceconomy.

Thefe investigations led me to dispute Mr, Hunter's opinion, to suggest and apply a different one, and make a few practical remarks upon the local treatment of the venereal disease.

Whenever I found necessity to dissent from Mr. Hunter's opinion, I have given my reasons. I have taken the liberty of doing so, conceiving that on all medical subjects, though the most respectful attention should be paid to the suggestions of celebrated men, yet that it is essential to the improvement of the healing art, that it be always considered as open to fair and temperate discussion.

In the last part of this work, I have remarked on the effects of the poison when in the circulating

PREFACE. »X

Jng fluid, and on the principal points in Mr. Hunter*s theory of lues venerea. Whether its effects are now venereal — whether the product of venereal sores be infectious — whether the poison continues to circulate in the blood, or is soon thrown out by the powers of the system — whether the poison accumulates — how the product of sores in lues becomes poisonous — whether the effects of the venereal poison be limited — whether the effects produced from the poison, externally applied, be made worse by the blood being tontaminated — whether the venereal disease be the immediate cause of others, &c.

This part ends with a few practical admonitions upon the cure of lues ; to which is appended, a summary of some of the opinions of Mr. Hunter, and those which I have adopted.

In the execution of this work, which I have found to be difficult, the subjects of which I hope the reader will think with me to be of some importance^ I have been under the painful necessity of differing in opinion from two modern and eminent authors. But in the practice of medicine, it is above all things necessary, that there should be no dictator. This science, so essentially connected with the happiness of man, for a long timx was under the bondage of names, and only began to rise to its

present

X PREFACE,

I know that innovation is not always beneficial, and that all speculation is dangerous when health is concerned. But if the reasoning of others has not been kept closely connected with physiological truths i if conclusions have been drawn contrary to just inferenccj caret'jl comparison, and reasonable analogy \ if theories have been agreed on, which wary CKperience v/ill not confirm 5 if opinions have been recommended, which when applied^ divert us from the right and safe practice. Ivi these cases, I trust, it will not only be pardonable to abandon those authorities v/hich we conceive to be erroneous, but it becomes a duty to submit all our contrary ideas to the investigation of others, tnat the general wisdom of the profession may confirm them if true, or expose them if fallacious.

1 publish this book with a hope, that an attempt to explain physiologically this distressing complaint, has some claim to approbation for its intention. Perhaps nothing is more wanting than a just habit of physiological reasoning. Every effort of this sort, therefore, deserves recommendation, even though the execution may not be successful.

There

PREFACE* Xt

There will be found in the following pages, a number of typographical and verbal errors, which have accidentally escaped my notice while the work was in the press i I have mentioned some of them in the following errata, for which, and the remainder, I beg leave to apologize.

Buckler shury^ Jan. 8, 1802.

ERRATA,

Page 45, line 4, " removed" read " accomplished."

52, line 23, " constitutes" read " establishes/'

■ 53, line 4, " of" read " is."

• 60, line 16, *' disease" read "cause."

CONTENTS rsc

Part I

Chap, I. Whether the same Poison p-oduces Gonorr^

hoea and Chancre - - - 1

Mr. Hunter's Ojiinion - • • ^3

Mr, Bell's O/miion •• - ^3

Cases and Reasoning on the Suhject - *3

Chap. II. Objections answered, and some of the difference betiueen the Sym/itoms and Effects of Gonorrhoea and Chancre explained 16

fVhy Gonorrhoea is not attended with Ulcer'- ation - - - - IS

TVhy Gonorrhoea does not as readily contaminate the Blood as Chancre - - ^0

Chemical and other Reasons why Gonorrhoea

does not often firoduce Chancre^ and Chan^

ere Gonorrhosa, in the sa7ns and different

Persons - - - - 21

CJiap. III. Observations on Mr, Be IPs Defence of

the Opinion he supports - » 2,5

Clap suddenly disapjiearing, and Lues Venerea not being the Consequence, 7i@ Proof of Mr, Bell's Opinion - - 31

Gonorrhea being a more frequent Occur" re nee than Lues Venerea ^ no Proof of Mr, BdVs O/iinion - - 37

SlV «ONTENtS«

?AGE

Another Evidence of Mr. BelVs^ examined 39 Chap. IV. Practical Admonitions on the Cure of

Part II

Chap. I. Effects of the Venereal Poison on the human Body, when externally ajiliUed 49 Chap. 11. A Review of Mr. Hunter s Theory of the

Continuation of the Venereal Disease 55

Chap. III. Physiology applied to efcem/ilify the Continuation and Extension of the Venereal Disease - - - 65

The Venereal Disease only communicated hy Poison - - - - 70

Conclusions - - - - 72

Chap. IV. A Review vf M\ Hunter's Theory of the

Production of Venereal Poison - 7i

Prefiaratory Observations - - 78

Jncomjiatibility of morbid Jctions with each »ther . - - . 79

Inconsistency of Mr. Hunter's Definition of Infamfnation - - - 83

Inconsistency of Mr. Hunter's Assertions res/iecti7ig the Nature of the Poison 84'

Mr. Hunter's Inquiry into the Cause of the poisonous Quality of the Matter 90

How far useful in explaining ihs Phoenomena of the Disease - - 92

Whether his Theory be consistent with Laws in the Animal CEconomy * - ^%

Chap.

CONTENTS, XV

Chap. V. Production of Venerea! Pohon - 105 Cha^. IVr Jfipllcation of the Fhysiolcgy adduced m

this Part - - - - 1 1 Q

How Gonorrhcea ceases without Medicine ib. How Gonorrhea ceases when the Patient is

sei%ed with Fever - - - 112

How Gonorrhcea censes from swelled Testicle 113

Venereal Disease arrested by other Diseases 114 How Venerea! Matter may bs more or less

- Virulent " „ - ib.

fVhy Mercury does not cure Gonorrhcea US How the Product of Venereal Sores may be poisonous after the Venereal Inflammation

has vanished - - - .11^

How the Disease relajises - -» ib.

Chap. VII. Practical Admonitions « - ilS

Part III

Chap. I. Effects of the Venereal Poison when circulating In the Blood - - 125 Chap, II. Whether the local Effects of the Poison^ when circulating In the Bloody be Venereal -« ■" - - 129 Hunter s Opinion - - - ib.

Ciap. III. Whether the Product of Sores In Lues

Venerea be poisonous - - 136

Mr. Hunter's Opinion - - ih.

Mr. Be!!' s Opinion - - 138

A Case upon the Subject - - 1 40

Mr. Hunter's Experiments^ i^c. - 142

Mt. Clutterbucli's Opinion - - ib.

Inferences deduced from Reason and Analogy 143

Chap.

^i CONTfeNTS;

Chap. IV. Whether the Pmson continues to circulate

in the Bloody or is soon thrown out 146

Mr. Hunter'' s Ojunion resfiecting the Poison

only irritating when first absorbed 148

His Oliinion of Disposition - - 149

His Opinion res[iecting Part cured^ becoming

again affected - - - ib.

Upon the Child in the Womb being cen-

taminated - - 150

Observations upon these Subjects • ib.

ji Case respecting the Subject - 15'i

Chap. V, Whether the Poison increases in the Blood 161 Ancient Opinion resjiectlng the Question ib.

Whether the Poison immediately causes the

The Juthcr'^s Opinion sufiported by Analogy 175 Chape VL How the Product of Sores in Luesy be^

comes poisonous - _ - 175

Cnap. VII. Whether the Effects of the Venereal Poison be limited - - * 177 Chap. VIII. Whether the Effects Jiroduced by the Poison^ externally ajipliedy be made worse by the Blood being contaminated - 181 Chap. JX. Whether the Fenereal Disease be the immediate Cause of others - - 181; Chap. X. Practical Admonitions - - 189 Summary - • • - 193

AN

INQUIRY

INTO THE EFFECTS

OF THE

VENEREAL POISON

ON THE

HUMAN BODY.

Part I Chapter L

WHETHER THE SAME POISON PRODUCES GONORRHCEA AND CHANCRE.

JL HE wildness of huftian imagination, when it rejects the steady guide of experience, proves to us the necessity of attending to the leader we have deserted. The errors of fancy urge us into labyrinths of difBculties, from which nothing can extricate us, but time, the experience we have under* valueda and a mature deliberation^

B T«

S PVhetlier the same Poison producer

To determine upon this question, we must take our faithful guide, experience, along with us — we must not dismiss her after conquering one or two difficulties, with an idea of saving ourselves the trouble which naturally occurs in attending her; we must retain her to the utmost extremity of our journey.

It is surprising that, though the venereal disease has been prevalent for about three centuries, this question should yet require disquisition.

Every inquiry, in which the health of our fellow creatures is implicated, is of great moment. The decision of the present involves the proper treatment of one branch of the disease, and with this treatment human health is most intimately connected.

As I am not attempting a history of the venereal disease, nor the rise of its doctrines, it will be sufficient for me to point out what seems to be the present state of the dispute.

It was for some time supposed, that the two diseases were of the same nature, and proceeded from the same kind of poison: after which, many imagined that they arose from two distinct poisons. Mr. John Hunter favours the first of these opini-

ons>

Gonorrhcea and Chancre^' 3

ons, andintitles his chapter, ^^ Of the poison being the same in gonorrhoea and in chancre." He states, that " it has been supposed by many, that the gonorrhoea and the chancre arise from two distinct poisons \' but he saysj ^^ that the matter of gonorrhea will produce either a gonorrhcea, a chancre, or the lues venerea ; and the matter of a chancre will also produce either a gonorrhoea^ a chancre^ or the lues venerea"^/'

Mr. Benjamin Bell, Edinburgh, supports the contrary opinion, and brings forward the question thus : ^' Whether gonorrhoea and lues venerea originate from the same contagion/' And he concludes, that '-^ they arise from diiterenc s-pedfic contagions-\,^*

After observing these cifTerent opinions, it is necessary, for a moment, to disregard both, to divest the mind as completely as possible of than prejudice to v^^hich human nature is so subject — to observe the course of experience, and diiigendy to seek after truths, which will alone benefit mankind, and stand the test of time.

* Hunter on the Venereal Disease, part i. ch. i. sec. v. f Bell's Treatise on Lues Venerea, ch, i, Mr, Bell published his Work in 1793,

B % Ths

4 Whether the same Poison produces

The contest seems to have originated from a

disagreement in the symptoms of gonorrhcea and

chancre, and their effects. It has been observed,

that they do not equally contaminate the system,

and produce lues venerea 5 and that the medicine

which almost universally cures chancre^ has less

effect upon gonorrhoea. But these, and such

like indisputable facts, we ought maturely to weigh.

They point out to us an existing cause for these

differences ; but they are not sufficient to warrant

a decided conclusion respecting the question.

May not these, and other disagreements, depend

upon other causes ?

We must inquire whether these differences are accidental^ owing to the nature of the part affected % or permanenty caused by the properties of the poison.

We must take into consideration, that the seat of the two diseases is different — that the same cause may produce different effects, upon different parts — that the same poison, when mixed with different fluids, may be more or less violent in its operations — acid that there may be greater or less attraction of certain fluids to a part, according to its nature and composition. These circumstances require us not to be precipitate in our conclusions, but to extend our researches.

Wr

Gonorrhoea and Chancre. S

We know little more of the poisons, than their effects upon the human body.

They are in a liquid form, and generally bring on such a state of the parts to which they are applied, that, in the end, a liquid is thrown cut by the vefiels of the part, which is mixed with the original poifon, and partakes of its properties.

When this is accomplished in the urethra, and without a breach of substance in the texture of the part, the effect is called gonorrhoea, and the matter is called gonorrhcsal poison.

Vv^hen an ulcer appears, upon the parts of generation, having certain characterizing marks, we call it a chancre, and affirm the presence of venereal poison. Certain other effects, as particular eruptions upon the skin, ulcerations in the throat and different parts of the body, &c. announce to us a system contaminated with venereal poison ; or that this poison has been received into the circuladng fluid.

All admit that poison to be venereal, which produces chancre, when externally applied ; and when received and circulated with the blood, lues venerea.

B 3 After

6 Whether the same Fohon produces

Afcer this virw of the dispute^ this statement of iht faces upon which we are to proceed, it would appear^ Vci^z iht true scientific manner of deter- Taming this qucsrion> is to inquire — if the two diseases e^^er produce each other— if gonorrhcsa ever coniaminaces the system, and produces lues venerea, — When this information is obtained, w^ may be allowed to speak decidedly upon the question, and employ our reason to explain the effects; but not before,

It appears to me, that if gonorrhcgal matter has clearly and decidedly produced chancre, or con* laminated the system in any one instance, the question is determined. It could, in no instance, produce these effects, unless it had the power of doing so. If it has this power, then it resembles the action of the matter of chancre, in its most essential characteristics. It will be universally acknowledged, that a musket-ball has the power of destroying life : yet, in a hundred cases, it may not produce that effect j but we do not, from these, deny the existence of the power. We account for the non-produciion of the fatal effect, by the concurilng ac^dental circumstances — the direction of the bail — the part it may strike — the intervention of any impediment, &c. I merely ask the same correct reasoning to be extended to the present question. I grant that gonorrhoea very

often,

Gonorrhoea and Chancre, 7

often, nay, most frequently, does not produce lues venerea; but I know that, in some cases, it has had this unhappy effect. I submit, we must, even in the other cases, admit the existence of the same power ; but look to the interposition of other causes, which have suspended the natural action of that power.

That the matter of gonorrhoea is the same with the matter of chancre, has been argued by Mr. Whately, who adduces several respectable opinions in his support*. To arrive at the truth, I have always made particular examinations into the cases which have occurred to me. The result of these examinations proves, that, in general, chancre produces chancre, and gonorrhoea gonorrhoea ^ but that this is not always the consequence. I will therefore mention a few cases which I have met with, which compel me to be clearly of opinion, that the poison of gonorrhoea may produce gonorrhoea, or chancre j and that it does produce the same effects as that of chancre, when received into the circulating fluid,

CASE I.

1796, Dec. 18th. A GENTLEMAN put himself under my care, for the cure of a clap. Upon most careful examination, not the least appear-

* Mr. Whately on Gonorrhoea Virulenta.

, B 4 »nce

S Whether the s&me Pchon produces

afice of ehancre was to be perceived. Upon the 30th of the same month, he begged I would call to see a female, whom he was afraid he had injured. Accordingly I did, and upon most attentive inspection, nothing but a clap could be detected, attended with its usual symptoms. Every circumftance which could be collected from the parties, after a careful inquiry, strongly corroborated the asserdon, that he was the person who had infected her. These circumstances, of course, I cannot detail j they w^ere, in general terms, the situation and disposition of the patient, and the decided opinion and judgment of the gentleman, together with the time of the appearance of the disease, which was about two days before I saw her : the intercourse had been on the nineteenth or twentieth. At that time, I was much of opinion, that the difference between chancre and gonorrhoea, 'was owing to a difference in the nature of the poison which caused them. The cure was undertaken by local remedies alone. The symptoms of the disease gave v/ay pretty easily, and endrely disappeared in the course of about two weeks ; but the same temedies were continued for some time, to prevent a return. On the 26th of January, 1797, when I was about to take leave o f her as being cured, she complained of an eruption which had appeared upon different parts of the body, attended with a considerable itching, and some slight fever. Upon examination, brownish coloured spots, about the size

of

Gonorrhoea and Chancre, 9

of a small split pea in circumference, were found upon different parrs of the body, but particularly the neck breast, and arms. The spots somewhat elevated the skin, and terminated with a lighter coloured margin — the tops of some of the oldest gave a scaly-like appearance, the floating edges of which were turned towards the apices. I was much surprised at these appearances, but could hardly persuade myself that they were venereal ; two or three days were allowed to elapse without doing any thing particular. Some circumstances prevented my seeing her for ten days, at the end of which time the spots appeared in greater numbers, attended with a foul spreading ulcer in the right tonsil. No doubt now remaining respecting the complaint, mercury v/as given according to circumstances, which accomphshed a cure.

I am aware that this, and all similar cases may be objected to, by the partizans of a different opinion to what this case points out ; but, if strictlyexamined, I think, this will micric some degree of attention.

If she had no intercourse with any other man, than the gentleman who was under my care, and who had a clap when the last intercourse took place, which 1 have mentioned to be about the 19th, then the infection which appeared a day

or l6 Whether tli£ same Fchon fi/oJuces

or two before the 3CLI15 came from him. It was he who communicated the disease^ the matter of which being received into the circulating bloody produced lues venerea. But should it be doubted that she had no other intercourse^ I would then say, whatever compiaint any other person had^ who tainted her, it produced only a clap, and I would draw the same conclusion ; for no other than a clap was at first apparent. If it be sdll urged, that, perhaps, there was chancre, but so situated that it v/as not percepdble. I would then answer, it is very improbable, for it is hardly to be supposed that the local remedies had cured it J if not, then some marks of it would have shewn themselves after the cure of the gonorrhoea.

CASE ir.

On the 3d of May, 1796, a v/ell-informed gentleman, from a distant county, applied to me for the cure of a violent clap, which had appeared a few days before. I carefully examined the part (v/hich is my constant practice in ail such cases, having seen mistakes arise from the want of this precaution) j but not the slightest appearance of chancre, or excoriation, was observed.

On the 1 6th, he entreated me to take the care of a female, whom he was apprehensive he had injured. The last connecdon happened about the first of

the

Gonorrliosa and Chancre, l\

the month, about which time his gonorrhoea appeared. He had not the smallest idea, but that if she was injured, he was the cause, being perfectly of opinion, that she had no intercourse with any other man. I am aware that such presumptions as these, are very apt to be fallacious. But, hov/ever, there are cases in which, from peculiarity of circumstances, the belief and conviction of a man of sound judgment, who is desired to be wary and discriminating on the subject, must have very great ^\ eight. Upon careful examination, I found a chancre on the left side near the orifice of the va^^ina, with an inflamed, hardened basis, elevated edges, and a bro.vnish white deadened bottom | she had also som.e pain and elargement in a gland in the groin on the same side. A clap, mild in its symptom.s, accompanied these. Some simple ointmient was applied to the sore; mercury, was given agreeable to circumstances 5 and, in about a month, the chancre was well. A slight astrin«, gent injection cured the clap in a fev/ days, li the evidences *of this case be true, it is an instance of gonorrhcsa communicating gonorrhoea and chancre.

CASE III,

In November, 1797, a gentleman put himself under my care for the cure of a clap — he had been apprised of its symptoms about three weeks,

and

12 Whether the same Poison produces

and had used different injections without any good c^tct, by the direction of a surgeon — he had not the smallest appearance, or vestige of a chancre, and he assured me he had not had any from the beginning — he had not taken any mercury. There was a sv/elling in the left groin, about the bigness of half a walnut, extremely tender, and a deep foul ulcer in the tonsil of the right side. Mercury was given so as to affect the svstem, and an injecdon used several times a day. The symptoms entirely disappeared in about a month.

CASE IV.

December, 1799> a stout healthy gentleman, about twenty years old, put himselt under my care for the cure of a clap, which he had felt £ome days ; t!at cure was attempted by 'injecdons, — it proved rather tedious ; in about a month, a fwelling took place in a gland of the left groin, and a venereal eruption upon different parts of the body. Mercury was now given pretty freely, notwithstanding which, the bubo suppurated, and was opened by the lancet. Mercury was continued according to its effect, and a cure accomplished in about two months.

In these two last casc^, there was lues without chancre, and following a gonorrhoea. Of course,