Gonorrhœa, syphilis, and other venereal diseases. Their symptoms, treatment, &c.

Front matter

COPYRIGHT DEPOSIT

PL I

Tvupia Prominens Syphilitica..

Preface

A few years since, the author of the following pages prepared an Essay on " The Constitutional Treatment of Syphilis," which was honored by the award of a premium from the Boylston Prize Committee of Harvard University. That Essay constitutes a large portion of the present volume ; and, although it has been modified to a degree that deprives it of its original identity, it is believed that its intrinsic merits have been materially enhanced.*

In the early part of my professional career, I had charge, for several years, of the hospital department of a large Charitable Institution, in which venereal patients, and those affected with blennorrhagic diseases daily presented themselves ; and I have now devoted more than thirty years to the therapeutics of syphilis and kindred disorders, as they may properly enough be termed. From time to time I have tested a great variety of remedies, and have pursued, by way of experiment, almost every line of treatment that has been brought to notice with any claims to favorable regard. But I have found no royal plan of accomplishing a speedy or certain removal of the maladies under consideration. They will yield to a judicious interposition of medical and surgical skill ; and no man, who posesses such skill, will confine himself to a few medicinal

* By a vote of 1826, the Board do not consider themselves as approving the doctrines contained in any of the dissertations to which premiums may be adjudged ; and in case of the publication of a successful dissertation, the author is considered bound to print this vote in connection therewith.

vi PREFACE.

substances that may have acquired notoriety as specifics, while they are endowed with no such qualities.

The paramount design which I have endeavored to keep in view, has been, to furnish a book that shall be practically useful. I have studiously avoided engaging, to any great extent, in the discussion of all doubtful matters. These have come before me with sufficient frequency. Scarcely had I entered upon my labors, before I found myself in the thorny wilderness of debate, where I was unable to maintain entire silence or neutrality.

The occurrence of blennorrhagia in the male, as resulting from leucorrhoea, or from the menstrual fluid, has long been a standing theme of controversy, and is still involved in obscurity. I flatter myself that the manner in which I have disposed of this subject, will receive the approbation of my readers generally. Certain I am, that the views I have advanced are in harmony with those maintained by men who have had the largest experience, and who have long been on the " look-out " for all the facts that are capable of reflecting any light upon this interesting question.

In adducing the cases which are interspersed throughout this volume, it has been my aim to select those that appeared to be important and valuable from the peculiar symptoms appertaining to them, as aiding in the diagnosis of different syphilitic accidents, or illustrating the principles of a rational and successful treatment. The details of a few of these cases occupy an unusual amount of space ; but it is hoped that the instruction which they are calculated to convey, will justify the prominence given them, and repay for the time required in their perusal.

It was a remark of John Hunter, in reference to distinguishing venereal from other affections, that a true diagnosis is the first step in the cure. In one sense, this idea may not be strictly logical or correct, that is, so far as relates to the individual lesion ; and yet, in a broader signification, the expression is

PREFACE. vii

worthy of all acceptation. A medical man may heal a chancre, or other syphilitic sore, without having any knowledge or suspicion of its real character. But, in this state of ignorance, he will be incompetent to officiate in the premises to the highest advantage. He cures the local symptom or difficulty, but not the patient. The morbific cause remains unchecked, to work further mischief, and, at a future day, to display its effects in the appearance of some new symptoms which might never have occurred had a true diagnosis been formed of the original trouble ; for such a timely discrimination would have suggested a constitutional remedial course more appropriate, it is presumed, than that which was instituted. Admonished by the words of the great medical philosopher above referred to, I have embraced every suitable opportunity to dwell, in brief and unambiguous language, upon the subject of the diagnosis of the various specific affections or consequences arising from impure sexual congress. It is hoped that the labor put forth in this direction will be found serviceable to the young and inexperienced physician, in his investigations of a class of obscure and perplexing cases, that occasionally present themselves for his decision and management. I have endeavored to delineate the characteristic features assumed by the various cutaneous affections resulting from the venereal poison, and by which the practised eye may generally distinguish them from non-specific eruptions. So far as. it has been deemed advisable to classify them, and to study them in separate divisions, the nomenclature of Professor "Wilson has, with little variation, been adopted. This arrangement will aid in observing and comprehending the laws that usually regulate the development of these external manifestations, and will greatly assist, also, in their diagnosis and treatment. The fact that some eruptions have a tendency to destroy the anatomical mechanism of the skin, — that is, to proceed to ulceration, — while others evince no such disposition, has induced that excellent writer, Mr. De Meric, to divide all 1 viii PREFACE.

syphilitic eruptions into two classes ; viz., the ulcerative and the non-ulcerative. By this short method of simplification, we get rid of sundry hard words employed by dermatologists ; but it seems to me that such an arrangement will fail to give to the student, or to the medical attendant, a clear and scientific knowledge of the respective forms which the syphilodermata exhibit, and that, in a practical or clinical point of view, it must be attended with no inconsiderable disadvantage. These diseases, at any rate, constitute a most important group of morbid phenomena, and require to be studied most thoroughly by every member of the profession who undertakes their cure. Not a few persons on whom they exist, and who apply for medical assistance, endeavor to deceive. They have interested motives for concealing the truth, and the physician is thrown into embarrassing circumstances. If, as a general rule, the latter can rely with safety on his own ability to give a true interpretation of the eruptions, — that is, if he can identify them without a knowledge of their antecedents, — he has no occasion to hesitate or succumb before the individual under examination. His intelligence and sound judgment will soon be apparent to the other party, who will not only be driven, like the fox, from his subterfuges, but will yield respect and confidence to the man whom he could not deceive.

The chapter devoted to the consideration of secondary syphilis, where no primary accident has preceded, contains, it is believed, a fair presentation of facts, and a truthful express sion of the sentiments recognized at the present day by a great majority of the most distinguished members of the* profession, who have had the most ample opportunities for acquiring knowledge upon the particular points concerning which they speak. The cases and data upon which their opinions are based, will be found to be something more than mere negations ; — nor are they brought forward for the vain purpose of establishing or demolishing any particular pathological theory, exclusive of other and higher considerations. It would

PREFACE. ix

seem that a candid appreciation of what is embodied in this chapter, would lead to the conviction that there is but a very narrow margin, or, rather, no ground at all, for controversy or doubt ; and yet there are those who discredit the evidence thus adduced and fortified. If the reader finds himself still roaming in the barren realms of skepticism, let him pause at least, and, in an unbiassed and philosophical spirit, listen to these facts as admonitory voices to his incredulity ; and let him glean therefrom a lesson of wisdom and prudence. This will be salutary both to himself and others, even if his mind be not fully emancipated from the influence of long-cherished opinions of an opposite kind ; for possibly he may be required, in the course of his professional life, and in virtue of his accredited superior attainments in whatever relates to his calling, to give his testimony, under the sanctity of an oath, on certain points at issue, in the solemn halls of justice, and intimately connected with this subject; and involving, among other things, the great question of the communicability of secondary syphilis.

No one can boast that he has witnessed and treated all the accidents entailed upon the human frame, by the promiscuous intercourse of the sexes. Whatever position he may occupy, it is scarcely within the range of possibility that his individual investigations, experience, and opinions, can be sufficiently comprehensive to embrace everything. The recorded observations and labors of others should be consulted. Accordingly, in gathering materials from which to construct the present treatise, I have devoted no little time to the perusal of various works on venereal and other specific affections engendered by the abuse of the reproductive organs ; and in the statements and views which I have offered, I have, in very many instances, made other writers participate in the responsibility. Numerous books, essays, lectures, and monographs have been published, and still have a name to live. Some of them are little else than an ingenious and gossamer fabric of conjectures,

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not ^infrequently dressed in a most fascinating style, and displaying the workings of a lively imagination. Some of them are remarkable for sound erudition ; some are enlivened with beautiful rhetorical strokes, and even glitter with the most brilliant corruscations of eloquence that can be found in any department of literature ; and some are replete with much practical good sense. On many topics appertaining to the subject of syphilis, a wide discrepancy of opinion characterizes the productions of the most gifted authors, even up to the present moment, and not a few grave problems still remain to be solved. Amid the conflict of sentiment which thus prevails, the student in pursuit of reliable information scarcely knows how to adjust his mind, or how to sever the true from the false — the wheat from the tares. On some of these points I have ventured to offer a helping hand, and to interpose a word of reconciliation, especially in the field of therapeutics.

For the most important discoveries that have been brought to light since the days of Hunter, in regard to the pathology of venereal disorders, — for various and most valuable suggestions and principles proposed for our guidance in their diagnosis, and for most useful rules and improvements in the remedial administrations which they require, — the writings and other services of Ricord are entitled to preeminent consideration. But Ricord is not infallible ; and, while rendering this willing tribute to his masterly genius, I feel compelled to add a slight qualification, and to withhold my assent from a few doctrinal views advocated by this distinguished syphilographer.

Chapter I. Pagb

Blennorrhagia. — Causes. — Leucorrhoea contagious. — Blennorrhagia not necessarily connected with Guilt. — Letter from Dr. Buckingham. — Diagnosis of Blennorrhagia. — Symptoms. — Terminates in Gleet. — Gleet and Matrimony, 13

Chapter II

Treatment of Blennorrhagia in the Male. — Cathartics. — Fomentations.

— Injections of Nitrate of Silver. — Danger of. — Balsam of Copaiba.

— Capsules. — Importance of Rest. — Cubebs. — Relapses of Gonorrhoea. — Cases. — Injections in Gonorrhoea. — Painful Erections and Chordee. — Lupulin. — Camphor. — Urethral Hemorrhage. — Cases, . 3 1

Chapter III

Gleet. — Symptoms. — Case. — Microscopical Appearance of the Discharge. — Treatment. — Blisters. — Injections. — The Bougie, . ... 60

Chapter IV

Balanitis. — Opinions respecting the Prepuce. — Glandulse Odoriferae. — Case of Pseudo-Balanitis. — Causes of Balanitis. — Symptoms. — Treatment. — Phymosis. — Slitting up the Prepuce. — Circumcision. — Paraphymosis. — Treatment, . 72

Chapter V

Orchitis produced by Cubebs or Copaiba. — The Epididymis the usual Seat of the Disease. — Symptoms. — Treatment. — Puncturing the Testis and Epididymis. — Compression of the Testis. — Dr. Fricke, Holmes, Coote ? Ricord, and Henry J. Johnson on the Subject, 82

Vegetations. — Are not venereal. — Are known by sundry Names. — Their Situation. — Their anatomical Structure. — Treatment. — Papillomata, 162

Chapter XVI

Blennorrhagia in the Female. — The Speculum. — Diagnosis of Blennorrhagia in the Female. — Blennorrhagia in very young female Children. — Varieties. — Chronic Vaginitis. — Uterine Blennorrhagia. — Treatment.

— Urethral Blennorrhagia in the Female, 168

*

CHAPTER XVn.

Syphilis. — But one Syphilitic Virus. — Its intrinsic Nature unknown. — Indurated Chancre of rare Occurrence. — Generally solitary. — Induration deceptive. — Interval between Exposure and morbid Phenomena.

— Abortive Treatment of Chancre, 187

Chapter XVIII

Constitutional Treatment of Chancre. — Principles of Health to be enforced. — Analyses of the Blood by M. Grassi. — Influence of Iodide of Potassium on the Blood. — Artificial Syphilization. — Methods of treating the Venereal Disease, 199

Chapter XIX

Chancre. — Indurated Chancre. — According to Ricord, can alone impregnate the System. — This Theory not sustained by Facts. — Indurated Chancre rarely followed by suppurating Bubo. — Mercury the best Agent for curing indurated Chancre. — Local Applications. — Swelled Tongue. — Ulcers on under Surface, 216

Lichen. — Diagnosis. — Passes into Tubercles. — Associated with Tubercles, Squama?, and Pustules — also with Iritis. — Treatment, .... 310

Chapter XXIX

Squamous Syphilitic Eruptions. — Are met with in young Subjects. — Their most prominent Features. — Errors in Diagnosis in Consequence f the Absence of the Copper Color. — Case. — The Squamae belong either to Psoriasis or Lepra. — Treatment, 325

Chapter XXX

Tubercular Syphilitic Eruptions. — Present various Appearances. — Sometimes ulcerate. — Sometimes disappear by Absorption. — Phagedaenic Ulcers, and Serpiginous Ulcers. — Perforating or Syphilitic Tubercles.

— Treatment of tubercular Eruptions — of ulcerated Surfaces. — Mucous Tubercles, 342

CONTENTS. xvii

Syphilitic Iritis. — Sometimes a secondary, sometimes a tertiary Affection.

— Symptoms. — Diagnosis. — Treatment. — Mercury. — Mr. Carmichael's Substitute. — Dr. H. W. Williams's Plan of Treatment, . . .391

Chapter XXXVI

Tertiary Syphilis. — Organs and Tissues involved. — Syphilis and Scrofula. Ricord, Lugol, and Phillips. — Tubercula Gummata. — Rarely met with. — Diagnosis. — Cases. — Syphilitic Gummata in the Muscles — Lungs — Liver — Brain — Bones, etc. — Treatment. — Iodide of Potassium, 401

Chapter XXXVII

Syphilitic Sarcocele, or Orchitis. — Belongs to no particular Period of Syphilis. — Commences in the Tunica Albuginea. — Suppy, ition rarely takes place in the Testicle. — Atrophy of the Gland. — iXhe Disease apt to recur. — Diagnosis. — Treatment, 416

Chapter Xxxviii

Diseases of the Periosteum and Bones. — Syphilitic Osteocopes. — Nodes.

— Cranial Exostoses. — Tumors on the Dura Mater. — Cases of Intra-cranial Affections related by Mr. Todd of London — by Dr. Reid of xviii CONTENTS.

Ireland. — Case related by Mr. Reeve. — Case in the Author's Practice. Case at Rainsford Island Hospital. — Diagnosis. — Treatment of Tertiary Pains — of Nodes. — Mercury. — Local Treatment, 421

Chapter XXXIX. Infantile Syphilis

Not always secondary. — Procreating Element the Medium of contaminating the Foetus. — Blight of Ovum and Abortion. — The Circulation the most common Mode of infecting the Foetus. — Infection rarely communicated to the Child by the parturient Mother. — The milk of a Syphilitic Nurse poisonous. — An Infant born with Syphilis cannot infect its Mother, but may a strange Wet-nurse, etc., 432