A treatise on diseases of the sexual system

Front matter

i v 0c

A TREATISE

DISEASES OF THE SEXUAL SYSTEM,

Chapter I

History of S^^philis ; its modern origin disproved ; alluded to in Leviticus, chap, xv ; and in Psalm xxxviii, Dr. Clarke's Commentary on ; statutes of Jane I. Queen of the Sicilies, and of Queen Elizabeth ; true method of investigation ; author's opinion of its origin.

Chapter II

Chancre defined ; first symptom ; does not always appear ; several kinds ; instant cure without medicine. Chapter III.

Bubo defined; second symptom; not constant; not always syphilitic ; time and place of its appearance ; treatment — local and constitutional.

Chapter XIV

Treatment of syphilis ; secondary and tertiary symptoms ; evils of quackery ; necessity of mercury ; accursed compounds of quacks ; author's opinion of the action of mercury ; fumigation ; inunction ; internal use of.

Chapter XV". i)a the duration of a mercurial course ; regimen to be enforced.

Chapter I

Gonorrhea defined ; totally different from syphilis ; period of attack ; first symptom ; originates from other causes than contact ; symptoms ; instant cure without medicine ; often exists with syphilis ; may be contracted at the same time ; cases. Chapter II.

Becond stage ; ardor urines ; chordee ; injections hurtful ; treatment.

Chapter VI

Strictures of the urethra ; sad result of quackery ; correct definition , always preceded by gleet ; impossibility of retaining urine ; situation and description of strictures ; spasmodic ; the use of injections, defended by experience and analogy.

Chapter VII

Cure of strictures ; various kinds of bougies ; use of them ; cure by caustic ; its legitimate use defined ; great caution requisite ; author's invention, with plate ; not to be used as a destructive agent ; monstrous nature of the proposition for forcing a stricture ; incision of stricture; author's invention.

Chapter VIII

Fistula?, or false passages in the urethra; operation for vaginal and rectal fistula? ; malformation of urethra, operation for ; remarkable case.

Chapter IX

Phimosis, paraphimosis, and circumcision ; admirable custom of the Jews ; a great preventive of disease ; operation on the adult frequently necessary ; case of; author's mode of operating.

Chapter X

Swellings and other enlargement of testicle ; venereal ; treatment ; sarcocele ; hardening of the epydidimis ; castration; hydrocele; do. of cord ; do. encysted ; do. anasarcous ; hematocele ; great importance of diagnosis ; different modes of treatment.

Chapter XI

Malignant, or cancerous diseases of the testicle ; fungus haematodes $ granular fungus ; diagnosis ; operation.

CONTENTS.

Chapter XII

Varicocele, or enlargement of the veins of the cord ; diagnosis ; van ous modes of cure ; new method of the author.

Chapter XIII

Cancer of the penis; do. of scrotum; sarcomatous enlargement of do ; imperforate vagina, operation for ; cases of author ; hermaphrodites explained; absurdity of such an idea; closure of the urethra, at birth ; polypus uteri ; instrument invented by the au thor, with plate ; cases.

Chapter XIV

Prolapsus of the vagina and womb, and leucorrhea ; causes of the former ;. utero-abdominal supporter invented by the author ; leucorrhea always cured by caustic ; author's speculum.

Chapter XV

Spermatorrhea; its causes venereal excess and onanism; cause" for these vices ; they are the origin of our physical infirmity and of consumption ; copulation only designed for the production of offspring ; absurd desire for youthful precocity; morbid development of nervous system.

Chapter XVI

Onanism ; derivation of word ; symptoms and general physiognomy ; the frequent cause of phthisis ; morbid development of nervous system of children ; mode of address to onanists; moral and surgical treatment ; author's caustic catheter, with plate ; author's speculum, with plate *, polypus ligator, do ; caustio stricture catheter, do

Appendix

On the treatment of strictures by internal incision, . . 265 Circumcision — its real object — a new method of curing seminal weakness, 272

Abortive urethra — a new operation, . . . . .277

The operations for varicocele, . . . . . .280

Loss of virility in young married people — an unsuspected cause, .......... 283

Preface

The writer of these pages is unwilling to subject himself to the aspersion which will probably follow their appearance, without an explanation of the motives that induced him to prepare them ; and as those who censure often doubt the statements of such as incur their animadversion, he hopes hy the nature and distinctness of an avowal rarely made by authors, as well as the internal evidence of the book itself, to obtain full credit for what he is about to say.

In the first place then, the motive is self-interest. The author has long been urged by numerous professional friends as well as patients, to publish such a book. Both, smarting under the influence of licensed and other quackery, have assured him that it would be approved by intelligent professional and other men. This, not only from conviction of the candour of his friends, but extensive personal observation, he believes. A diversified practice of fifteen years' duration, with a minute and comprehensive knowledge of the medical policy of the day, has entirely convinced him that the most effective causes are operating, to break down the slender barrier hitherto existing, between the accomplished surgeon and the vilest empyric. This has long rested on a foundation as feeble as the public intelligence on medical subjects, and the only wonder is, that it has so long withstood the onslaught : the late act of the legislature is the legitimate sequence of its own miserable policy, in granting to colleges monopolies to teach, or rather to huckster diplomas.

The profession is now open to all : — yes, so far as the fostering care of that great " caterer and dry nurse of the state "

X PREFACE.

an American legislature can extend its maternal anrjS, the most profound of our number may enter the lists for public favor, with his boot black. This kind protection of the public health 3 was absolutely a necessary appendage to their previous enlightened act ; for these colleges, alas for poor humanity, have been animated with such persevering zeal for the numerical, not the intellectual strength of their graduates, (upon the yearly number of whom the subsistence of many of their professors entirely depends,) that the country is flooded by men totally destitute either by education or habits of philosophic thought, for the profession to which they have so unhappily been admitted.

This has gradually destroyed the only perceptible difference between the physician and the patient : for although a specious and bland exterior, or as Bacon hath it, " a person excellently well qualified for artifice in general," will do much to ensure respect, still the absence of a thorough education, will in a protracted and difficult case, often convince the attendant that it is unwise to make indefinite calculations upon the stupidity of his patient ; he will eventually require an explanation of his treatment, which however incompetent to understand, he will so much the more pertinaciously demand- From a deficiency in the medical education of his attendant, this may be difficult ; to a person thus situated, we say in all candour, possess yourself of this little book ; 'twill give the necessary information, and make your patient tractable ; whilst you go home and consult some of those great authors you would have been obliged to study, had you been properly educated ; and for fear the patient should discover your motive should you present him with the volume, tear out nicely this preface, and leave the blank leaves that intervene expressly for this purpose. So much for interest ; and it will be seen we anticipate an extensive sale.

In addition to a description of numerous delicate and distressing affections to which we are all liable, and which require

PREFACE. XI

the utmost nicety of discrimination and treatment, we have attempted to show how the very sources of its earliest existence in its mother's womb, are impressed by the vices of its parents ; and to trace the web of error that is wound round the nervous system of the little infant, even from the pure fountain of maternal love, till having entered the " dark labyrinth of sin," he presents himself to the surgeon, a fellowbeing of ungoverned passion, with his very life-blood sapped in the citadel ; he has imbibed

" The leperous distilment; whose effect Holds such an enmity with blood of man, That, swift as quicksilver, it courses through The natural gates and alleys of the body — Curdling like eager droppings into milk, The thin and wholesome blood."

And it his duty to give the patient the benefit of his hearty sympathy, and all the aid that modern science can afford The reader cannot fail to perceive that the whole object o* the book is to prevent the folly of an attempt at self-treatment. Surely, if we have been successful in enumerating half the legitimate consequences of the affection, none but a madman would attempt to tamper with himself.

We have spoken at length on the primary symptoms, because it is in that stage that he is most susceptiie of scientific treatment. Alas ! how often does he present himself in the loathsome condition of secondary disease, when perhaps, the merciless ignorance of quackery has exhausted itself upon him, and he becomes conscious of his credulity. How often at a period of life when the glad heart leaps at the very consciousness of existence, and he beholds his companions buoyant with hope and the elastic energy of youth, surrounded with all the endearments of conjugal and parental love, — the sweet smile of infantile innocence lisping the name of father —mother ; — his melancholy condition of disease and decay sheds its subduing influence on the spirit, and he awakes to his true condition. Well did David exclaim, " There is no

Xll PREFACE.

soundness in my flesh because of thine anger." " My heart panteth, my strength faileth, as for the light of mine eyes it is gone out from me."

Under such emotions, it was once the sad fortune of the writer to witness the death of a noble young man by his owi» hand ; the symptoms, after repeated affections had become utterly unmanageable, and his physician a most amiable and skilful man, to4d but too plainly by his 'countenance his lost hope ; he seized a razor and severed both the jugulars, ere his hand could be arrested or even his purpose known, thus ending his sorrows in the grave, where the light of hope and life had nearly expired together.

It is from despair like this that the humane surgeon is to rescue the victim of passion, and it is his duty to prevent the soul-sickening anguish of many a mother's heart, ere it become her sad fate to reflect, that her unborn babe is poisoned in the secret springs of its existence, and, instead of the invocation for its safety, her prayer shall be that its death may be granted her as the most merciful boon of Heaven. It is indeed often the case that the surgeon is called to treat disease of this very character in the bosom of domestic life, where all around gives evidence of happiness : alas,

" That lust, though to a radiant angel linked, Will sate itself in a celestial bed And prey on garbage.'' 1

Yet this is one of the many pages of life presented to us, and, whilst we cannot prevent the melancholy fact, let us apply our best efforts for the removal of the consequence : how far this will assist the profession is yet to be seen. The writer will only add, that though their approbation will be agreeable, their censure will not distress him.

Chapter I. History Of Syphilis

There are so many points of interest connected with the history of syphilis, not only to the physician and general reader, but also in a medico-legal point of view, that I shall offer no apology for the length of the first chapter, but my regrets that it has not been done in a more acceptable manner.

The reasoning advanced on its origin, is in accordance with principles recognized by some of the highest names in our profession. Not only bibliography, but facts and analogy, tend to confirm it; and although the idea of there being constantly entire new points for its origination, by means of morbid secretions, would seem to favour the belief that both the varieties of venereal, syphilis and gonorrhea, might occasionally merge into each other, as was supposed by Mr. Hunter, and involve the treatment in obscurity, still, I apprehend no such result in the hands of judicious practitioners. Neither is it likely that this volume will be read by them, if perchance it should not be entirely condemned from opposition to popular instruction. The writer well knows, and long himself held the same doctrine, that by no possibility could the people be informed on medical subjects. Increased knowledge of men and things has taught him better, and he now sincerely believes, that the blasting influence of quackery might 1

M HISTORY OF SYPHILIS.

long since have been checked, had the profession devot ed half the effort they have made, in instructing the public, rather than opposing them.

The importance of the subject of the occasional reorigination of syphilis, is very great; and although I certainly have never met with a case, in which I had reason to believe this has occurred in syphilis, I can by no means say the same of gonorrhea, for I firmly believe I have, and by parity of reasoning, on syphilis, a like result will follow.

Although ulcers of the genital organs are mentioned in Hyppocrates and other ancient writers, the Bible furnishes us with the first written assurance of syphilis ; and it is very evident that Moses, that profound legislator and physiologist, well knew its nature ; see Leviticus, chapter xv. —

" 1. And the Lord spake unto Moses and to Aaron, saying,

" 2. Speak unto the children of Israel, and say unto them, When any man hath a running issue out of his flesh, because of his issue; he is unclean.

"3. And this shall be his uncleanness in his issue; whether his flesh run with his issue, or his flesh be stopped from his issue, it is his uncleanness.

" 4. Every bed whereon he lieth that hath the issue, is unclean ; and everything whereon he sitteth, shall be unclean.

" 5. And whosoever toucheth his bed, shall wash his clothes, and bathe himself in water, and be unclean until even.

" 6. And he that sitteth on any thing whereon he sat

HISTORY OF SYPHILIS. O

that hath the issue, shall wash his clothes, and bathe himself in water, and be unclean until even."

The rest of this chapter is devoted to an explanation of the necessary ablutions and offerings to be made by the male, and female ; for in verse xix. we have a similar injunction for her, viz. " If a woman have an issue, and her issue in her flesh be blood, she shall be put apart seven days ; and whosoever toucheth her shall be unclean until the even." Then follow still more emphatic commands respecting the menstrual period, to which, there is no doubt, the preceding injunction refers — vers* xxiv. to which we refer the reader, preferring to add, in its ptace, the commentary of the learned Dr. Adam Clarke, — see Commentary on the 15th chapter of Leviticus. " When any man hath a running issue," &c. " The cases of natural uncleanness, both of men and women, mentioned in this chapter, taken in a theological point of view, are not of sufficient importance to us to render a particular description necessary, the letter of the text being, in general, plain enough. The disease mentioned in the former part of this chapter, appears to some to have been either the consequence of a very bad affection, or of some criminal indulgence ; for they find that it might be communicated in a variety of ways, which they imagine are here distinctly specified. On this ground, the person was declared unclean, and all commerce and communion with him strictly forbidden. The septuagint renders " ha-zab," the man with the issue, by o yovo^vyj^ the man with a gonorrhea, no less than nine times in this chapter, and that it means, what, in the present day, is commonly understood by

4 HISTORY OF SYrHILIS.

that disorder, taken not only in its mild, but in its worst sense, they think there is little room to doubt. Hence they infer, that a disease which is supposed to be comparatively recent in Europe, has existed almost from time immemorial in the Asiatic countries ; and that it ever has been, in certain measures, what it is now ; and that it ever must be the effect of sensual indulgence, and illicit and extravagant intercourse between the sexes. The disgraceful disorder referred to here, is a foul blot which the justice of God, in the course of providence, has made, in general, the inseparable consequent of these criminal indulgences, and serves, in some measure, to correct and restrain the vice itself. In countries where public prostitution was permitted, where even it was a religious ceremony among those who were idolaters, this disease must have been frequent and prevalent. When the pollutions and libertinism of former times are considered, it seems rather strange that medical men should have adopted the opinion, and consumed so much time in endeavouring to prove it, viz. that the disease is modern. It must have existed, in a certain measure, ever since prostitution prevailed in the world ; and this has been in every nation of the earth, from the earliest era. That the Israelites might have received it from the Egyptians, and that it must, through the Baal-peor and Ashteroth abominations, which they learned and practised, have prevailed among the Moabites, &c, there can be little reason to doubt. Supposing this disease to be at all hinted at here, the laws and ordinances enjoined were at once wisely an'd graciously calculated to remove and prevent it. By contact, contagion of every

HISTORY OF SYPHILIS. O

kind is readily communicated ; and to keep the whole from the diseased, must be essential to the check and eradication of a contagious disorder. This was the wise and grand object of this most enlightened legislator, in the ordinances which he lays down in this chapter. I grant, however, that it was probably of a milder kind in ancient times ; that it has gained strength and virulence by continuance ; and that, associated with some foreign causes, it became greatly exacerbated in Europe about 1493, the time in which some have supposed it fir*t began, though there are strong evidences of its existence in this country ever since the eleventh century." So far Dr. Clarke's learned commentary on this interesting matter, we have no doubt, will very satisfactorily precede any ideas of our own ; and as it is more than probable our use of his commentary, as well as his own explanation, will be condemned by well-meaning, though prejudiced readers, we think it right to give the full benefit of all existing light on our subject to be derived from the Bible ; we shall therefore continue our reference to that work.

The ordinance so wisely promulgated by Moses, dates as early as 1400 B. C. More than five hundred years later, the xxxviii. Psalm was written, on which we find the following expressive announcement by Dr. Clarke, vide his Commentary: — " Several conjectures have been made relative to the occasion on which this Psalm was composed ; but it does not appear that, out of all the titles given it, we can gather the true intent of the Psalm : the most likely is, that it was in reference to gome severe affliction which David had, after his illicit 1*

6 HISTORY OP SYPHILIS.

commerce with Bathsheba ; but of what nature we are left to conjecture from the third, fifth, and seventh verses."

There can be little doubt that Bathsheba, from her willingness to assent to David's propositions, was a person who valued her virtue very lightly, notwithstanding the possession of a husband, of so many graces, and such distinguished valor. The exposure of her person, whilst bathing, to the public gaze, (to what extent we are not informed, though it seems it attracted the notice of David from the roof of his house,) was sufficient evidence of her lightness of character, and the probability of her being affected with venereal. The Psalm is dated, B. C. 1034, not quite one year after the disgraceful act, or enough for the developement of syphilis in its worst form.

" 3. There is no soundness in my flesh because of thine anger ; neither is there any rest in my bones because of my sin."

Pain in the bones, or rather, as the reader will see in the symptoms of secondary syphilis, in their investing membranes, and the deeper ligamentous structures of the body generally, is common in syphilis. Dr. Clarke remarks, " This seems to refer to some disorder which so affected his muscles as to produce sores and ulcers."

" 5. My wounds stink and are corrupt, because of my foolishness."

" Taking this in connexion with the rest of this Psalm, I do not see that we can understand the word in pxij figurative or metaphorical way. I believe they

HISTORY OP SYPHILIS. 7

refer to some disease with which he was at this time afflicted: but whether the leprosy, the smallpox, or some other disorder that had attacked the whole system, and showed its virulence on the different parts of the surface, cannot be absolutely determined.

" 7. For my loins are filled with a loathsome disease : and there is no soundness in my flesh."

Dr. Clarke — " Or, rather, a hurning; nikelah, from kalah, to /ry, scorch, &c. ; hence nikelah, a burning or strongly feverish disease."

" 10. My heart panteth, my strength faileth me : as for the light of mine eyes, it is also gone from me."

" There is no soundness in my flesh." — " All without and all within bears evidence that the whole of my solids and fluids are corrupt."

" 11. My lovers and my friends stand aloof from my sore; and my kinsmen stand afar off."

" For fear of being infected by my disease."

It would certainly be difficult for the most eloquent and observing physician, to describe the secondary symptoms of an aggravated case of syphilis, with more graphic earnestness, than is here set forth. It had not only affected the entire circulating system, but even the eyes, with some one of the three principal varieties of inflammation of that organ. See chapter x.

To the unbiased mind, there can be no reasonable doubt that the above quotations allude to syphilis ; and we think Dr. Clarke's Commentary conclusive. Moreover, when we come to treat of some other diseases of the penis, we shall show conclusively, that the enlightened and humane right of circumcision, in connection with

8 HISTORY OP SYPHILIS.

proper ablution, so often and forcibly enjoined by Scripture, is the most efficient way to prevent the occurrence of the disease.

Hyppocrates, who lived 460 B. C, describes ulcers of the genital organs of both sexes, as of frequent occurrence. Now, though these were not called syphilitic, their frequent occurrence in so suspicious a locality, is evidence enough of their contagious character. A host of writers follow, who describe so many ulcers affecting these parts, that it is really difficult to conceive what use writers could assign these organs, that rendered them so peculiarly unfortunate, who try to support the idea of its modern origin.

A very curious document is preserved, from the statutes of Jane I., Queen of both the Sicilies, respecting the regulation of the public stews of Avignon, in 1347. W^ cannot withhold our approbation from the truly kind and philosophic attention of her majesty to the welfare of her subjects, however her delicacy may be questioned. The document is as follows : — " The Queen commands, that on every Saturday the women of the house be singly examined by the abbess, and a surgeon, appointed for that purpose by the directors, and if any of them have contracted any illness by their whoring, that they should be separated from the rest, and not suffered to prostitute themselves, for fear the youth who have to do with them catch their distempers."

Queen Elizabeth, who found, if report say true, a peculiar use for the finest of her male subjects, despite a proper attention to maidenly decorum, made the

HlbTORV OF SYPHILIS. 9

enactment, " that every male in her train of attendants, who had a running from the pentle, should pay into the public treasury forty shillings."

About the year 1500, a writer, Benedict Victorius, advanced some curious views, to the correctness of which the more astute philosophy of the present day would find it rather difficult to assent, viz. that the venereal disease was epidemic, and originated, in his own words, " from an unwholesome disposition in the air," and " a spontaneous corruption of the humors, contracted by an error in diet, or the abuse of the non-naturals." This writer seems, moreover, to have found it necessary to defend la belle France, from a mischievous imputation, by the English, of having originated it, by their wickedly calling it Morbus Gallicus. He produced an elaborate essay, going to prove that the state of the air, together with that of the putrid humors, is sufficient to produce it ; and to put the matter beyond all doubt, he testifies that he happened to know " some very worthy and religious nuns, who were confined in the strictest manner, unfortunately contract the disease, from the peculiar state of the air, together with that of the putrid humors, and the weakness of their habit of body." This doctrine, though at the present day we smile at its absurdity, was really not only believed, but stoutly defended by physicians, many of whom being monks, and of course immaculate, and having access to nunneries, may have had some private reasons for their pertinacious adherence to their own tenets.

In 1496, the French, who had no such reasons, so far believed this absurdity, as to pass an edict, that all

10 HTSTORY OF SYPHILIS.

who had venereal, on pain of death, should be prohibited from conversing with the rest of the world, and retire to St. Germains, to places set apart for that purpose.* Nevertheless we find certain sagacious old doctors,, in England, as late as 1380, who give reason to suppose, by their treatment, that they had no views grounded on the innocence of the nuns. They went at it in a workmanlike way, and cured up their patients, secundem artem, paying very little attention to the agency of the air, or the non-naturals. About the same period, a very learned Latin author, John Gadisses, gives ample proof that he knew of its contagious nature, and was very successful in its treatment.

Without dwelling longer on the history of the disease, I will merely remark, that after long disputes about its identity with leprosy, its originating in America, and being brought to England by Columbus's sailors, the peculiar kind of venereal found, on the discovery of this country, in Canada, the Sivvens of Scotland, the Yaws of Africa, the Judham of the Jews, and the Venereal of Norway, — it was reserved for the genius of the English, to investigate this subject philosophically, by directing their attention to the general laws of the diseases of that peculiar membrane, called mucous, that lines the genital organs of both sexes. That this is the only philosophic plan of investigating the nature of the disease, is evident, not only from the absurdity of supposing a single point of the whole

* This edict related to the disease that broke out during the siege of Naples. Now there is great doubt if this was actually syphilis, a& the reader will see directly that it was communicated without contact.

HISTORY OF SYPHILIS. II

earth's surface for its origin, when the genital organs, being of similar structure and functions, must inevitably have been affected with similar general diseases, throughout the world ; and if the general results of inflammation, for example, were the same, why not the individual one in question, or the secretion of a specific poison, from similar, though inappreciable causes. See, for one moment, what forcible analogies may be found ; — the specific virus of a mad dog's saliva, invariably produces similar results all over the world ; and yet it is constantly originating, de novo. Why ! those who would have a single point of origin — as from America — might as well assert that all rabid dogs were in turn bitten by each other, and that the necessary antecedent to hydrophobia, was to be from some one individual of the species. Yet this would be deemed an absurdity. Moreover, the reader will see the various effects produced upon different constitutions by the same virus; and, as it has always been known that the secretions even of healthy individuals, have their essential differences, (the dog even distinguishing the smell of his own master,) is it not a fair inference, that dis ease would produce equal changes in the secretions of the private parts, and that these secretions might, when united with others, become specific.

Again, it is well known, in the various modifications of Leucorrhea — a disease to which the most virtuous females are subject — under this same law, from the most simple state, this very disease will pass into the most virulent and distressing one, producing great irritation and offensive discharge, and often affecting theii