PART II. OF DISEASES. (continued 7)

On the first appearance of these symptoms the patient should drink large quantities of new milk and sallad oil till he vomits; or he may drink warm water mixed with oil. Fat broths are likewise proper, provided they can be got ready in time. Where no oil is to be had, fresh butter may be melted and mixed with the milk or water. These things are to be drank as long as the inclination to vomit continues. Some have drank eight or ten English quarts before the vomiting ceased; and it is never safe to leave off drinking while one particle of the poison remains in the stomach.

These oily or fat substances not only provoke vomiting, but likewise blunt the acrimony of the poison, and prevent its wounding the bowels; but if they should not make the person vomit, half a 475drachm or two scruples of the powder of ipecacuanha must be given, or a few spoonfuls of the oxymel or vinegar of squills may be mixed with the water which he drinks. Vomiting may likewise be excited by tickling the inside of the throat with a feather. Should these methods however fail, half a drachm of white vitriol, or five or six grains of emetic tartar, must be administered.

If tormenting pains are felt in the lower belly, and there is reason to fear that the poison has got down to the intestines, clysters of milk and oil must be very frequently thrown up; and the patient must drink emollient decoctions of barley, oatmeal, marsh-mallows, and such like. He must likewise take an infusion of senna and manna, a solution of Glauber’s salts, or some other purgative.

After the poison has been evacuated, the patient ought, for some time, to live upon such things as are of a healing and cooling quality; to abstain from flesh and all strong liquors, and to live upon milk, broth, gruel, light puddings, and other spoon meats of easy digestion. His drink should be barley-water, linseed-tea, or infusions of any of the mild mucilaginous vegetables.

VEGETABLE POISONS, besides heat and pain of the stomach, commonly occasion some degree of giddiness, and often a kind of stupidity or folly. Persons who have taken these poisons must be treated in the same manner as for the mineral or corrosive.

Though the vegetable poisons, when allowed to remain in the stomach, often prove fatal; yet the danger is generally over as soon as they are discharged. Not being of such a caustic or corrosive nature, they are less apt to wound or inflame the bowels than mineral substances: no time, however, ought to be lost in having them discharged.

476Opium, being frequently taken by mistake, merits particular attention. It is used as a medicine both in a solid and liquid form, which latter commonly goes by the name of laudanum. It is indeed a valuable medicine when taken in proper quantity; but as an over-dose proves a strong poison, we shall point out its common effects, together with the method of cure.

An over-dose of opium generally occasions great drowsiness, with stupor and other apoplectic symptoms. Sometimes the person has so great an inclination to sleep, that it is almost impossible to keep him awake. Every method must however be tried for this purpose. He should be tossed, shaked, and moved about. Sharp blistering-plasters should be applied to his legs or arms, and stimulating medicines, as salts of hartshorn, &c. held under his nose. It will also be proper to let blood. At the same time every method must be taken to make him discharge the poison. This may be done in the manner directed above, viz. by the use of strong vomits, drinking plenty of warm water with oil, &c.

Mead, besides vomits, in this case, recommends acid medicines with lixivial salts. He says, that he has often given salt of wormwood mixed with juice of lemon in repeated doses with great success.

If the body should remain weak and languid after the poison has been discharged, nourishing diet and cordials will be proper; but when there is reason to fear that the stomach or bowels are inflamed, the greatest circumspection is necessary both with regard to food and medicine.

477

OF THE BITES OF POISONOUS ANIMALS.

We shall begin with the bite of a mad dog, as it is both the most common and dangerous animal-poison in this country.

The creatures naturally liable to contract this disease are, as far as we yet know, all of the dog kind, viz. foxes, dogs, and wolves. Hence it is called the rabies canina, or dog madness. Of the last we have none in this island; and it so seldom happens that any person is bit by the first, that they scarce deserve to be taken notice of. If such a thing should happen, the method of treatment is precisely the same as for the bite of a mad dog.

The symptoms of madness in a dog are as follow: At first he looks dull, shews an aversion to food and company: he does not bark as usual, but seems to murmur, is peevish, and apt to bite strangers: his ears and tail droop more than usual, and he appears drowsy: afterwards he begins to loll out his tongue, and froth at the mouth, his eyes seeming heavy and watery: he now, if not confined, takes off, runs panting along with a kind of dejected air, and endeavours to bite every one he meets. Other dogs are said to fly from him. Some think this a certain sign of madness, supposing that they know him by the smell; but it is not to be depended on. If he escapes being killed, he seldom runs above two or three days, till he dies exhausted with heat, hunger, and fatigue.

This disease is most frequent after long, dry, hot seasons; and such dogs as live upon putrid stinking carrion, without having enough of fresh water, are most liable to it.

478When any person has been bit by a dog, the strictest inquiry ought to be made whether the animal was really mad. Many disagreeable consequences arise from neglecting to ascertain this point. Some people have lived in continual anxiety for many years, because they had been bit by a dog which they believed to be mad; but, as he had been killed on the spot, it was impossible to ascertain the fact. This should induce us, instead of killing a dog the moment he has bit any person, to do all in our power to keep him alive, at least till we can be certain whether he be mad or not.

Many circumstances may contribute to make people imagine a dog mad. He loses his master, runs about in quest of him, is set upon by other dogs, and perhaps by men. The creature, thus frightened, beat, and abused, looks wild, and lolls out his tongue as he runs along. Immediately a crowd is after him; while he, finding himself closely pursued, and taking every one he meets for an enemy, naturally attempts to bite him in self-defence. He soon gets knocked on the head, and it passes currently that he was mad, as it is then impossible to prove the contrary.

This being the true history of, by far, the greater part of those dogs which pass for mad, is it any wonder that numberless whimsical medicines have been extolled for preventing the effects of their bite? This readily accounts for the great variety of infallible remedies for the bite of a mad dog, which are to be met with in almost every family. Though not one in a thousand has any claim to merit, yet they are all supported by numberless vouchers. No wonder that imaginary diseases should be cured by imaginary remedies. In this way, credulous people first impose upon themselves, and then deceive others. The same medicine which was supposed 479to prevent the effects of the bite, when the dog was not mad, is recommended to a person who has had the misfortune to be bit by a dog that was really mad. He takes it, trusts to it, and is undone.

To these mistakes we must impute the frequent ill success of the medicines used for preventing the effects of the bite of a mad dog. It is not owing so much to a defect in medicine, as to wrong applications. I am persuaded, if proper medicines were administered immediately after the bite is received, and continued for a sufficient length of time, we should not lose one in a thousand of those who have the misfortune to be bit by a mad dog.

This poison is generally communicated by a wound, which nevertheless heals as soon as a common wound: but afterwards it begins to feel painful, and as the pain spreads towards the neighbouring parts, the person becomes heavy and listless. His sleep is unquiet with frightful dreams; he sighs, looks dull, and loves solitude. These are the forerunners, or rather the first symptoms of that dreadful disease occasioned by the bite of a mad dog. But as we do not propose to treat fully of the disease itself, but to point out the method of preventing it, we shall not take up time in shewing its progress from the first invasion to its commonly fatal end.

The common notion, that this poison may lie in the body for many years, and afterwards prove fatal, is both hurtful and ridiculous. It must render such persons as have had the misfortune to be bit very unhappy, and can have no good effects. If the person takes proper medicines for forty days after the time of his being bit, and feels no symptoms of the disease, there is reason to believe him out of danger.

480The medicines recommended for preventing the effects of the bite of a mad dog, are chiefly such as promote the different secretions, and antispasmodics.

Dr. Mead recommends a preventive medicine, which he says he never knew fail, though in the space of thirty years he had used it a thousand times.

The Doctor’s prescription is as follows:

“Take ash-coloured ground liver-wort, cleaned, dried, and powdered, half an ounce; of black pepper powdered, a quarter of an ounce. Mix these well together, and divide the powder into four doses; one of which must be taken every morning fasting, for four mornings successively, in half an English pint of cows milk warm.

“After these four doses are taken, the patient must go into the cold bath, or a cold spring or river, every morning fasting, for a month; he must be dipped all over, but not stay in (with his head above water) longer than half a minute, if the water be very cold. After this he must go in three times a-week for a fortnight longer.

“The person must be bled before he begins to use the medicine^[161].”

We shall next mention the famous East India specific, as it is called. This medicine is composed of cinnabar and musk. It is esteemed a great antispasmodic; and, by many, extolled as an infallible remedy for preventing the effects of the bite of a mad dog.

481“Take native and factitious cinnabar, of each twenty-four grains, musk sixteen grains. Let these be made into a fine powder, and taken in a glass of arrack or brandy.”

This single dose is said to secure the person for thirty days, at the end of which it must be repeated; but if he has any symptoms of the disease, it must be repeated in three hours.

The following is likewise reckoned a good antispasmodic medicine:

“Take of Virginian snake-root in powder, half a drachm, gum asafœtida twelve grains, gum camphire seven grains; make these into a bolus with a little syrup of saffron.”

Camphire may also be given in the following manner:

“Take purified nitre half an ounce, Virginian snake-root in powder two drachms, camphire one drachm; rub them together in a mortar, and divide the whole into ten doses.”

Mercury is likewise recommended as of great efficacy, both in the prevention and cure of this kind of madness. When used as a preventive, it will be sufficient to rub daily a drachm of the ointment into the parts about the wound.

Vinegar is likewise of considerable service, and should be taken freely, either in the patient’s food or drink.

These are the principal medicines recommended for preventing the effects of the bite of a mad dog. We would not however advise people to trust to any one of them; but from a proper combination of their different powers, there is the greatest reason to hope for success.

The great error in the use of these medicines lies in not taking them for a sufficient length of time. They are used more like charms, than medicines intended to produce any change in the 482body. To this, and not to the insufficiency of the medicines, we must impute their frequent want of success.

Dr. Mead says, that the virtue of his medicine consists in promoting urine. But how a poison should be expelled by urine, with only three or four doses of any medicine, however powerful, it is not easy to conceive. More time is certainly necessary, even though the medicine were more powerful than that which the Doctor prescribes.

The East India specific is still more exceptionable on this account.

As these and most other medicines, taken singly, have frequently been found to fail, we shall recommend the following course:

If a person be bit in a fleshy part, where there is no hazard of hurting any large blood-vessel, the parts adjacent to the wound may be cut away. But if this be not done soon after the bite has been received, it will be better to omit it.

The wound may be dressed with salt and water, or a pickle made of vinegar and salt, and afterwards dressed twice a-day with yellow basilicon mixed with red precipitate of mercury.

The patient should begin to use either Dr. Mead’s medicine, or some of the others mentioned above. If he takes Mead’s medicine, he may use it as the Doctor directs for four days successively. Let him then omit it for two or three days, and again repeat the same number of doses as before.

During this course, he must rub into the parts about the wound, daily, one drachm of the mercurial ointment. This may be done for ten or twelve days at least.

When this course is over, he may take a purge or two, and wait a few days till the effect of the mercury be gone off. He must then begin to use the cold bath, into which he may go every morning 483for five or six weeks. If he should feel cold and chilly for a long time after coming out of the cold bath, it will be better to use a tepid one, or to have the water a little warmed.

In the mean time, we would advise him not to leave off all internal medicines, but to take either one of the boluses of snake-root, asafœtida, and camphire; or one of the powders of nitre, camphire, and snake-root, twice a-day. These may be used during the whole time he is bathing.

During the use of the mercurial ointment, the patient must keep within doors, and take nothing cold.

A proper regimen must be observed throughout the whole course. The patient should abstain from flesh, and all salted and high-seasoned provisions. He must avoid strong liquors, and live mostly upon a light and rather spare diet. His mind should be kept as easy and cheerful as possible, and all excessive heat and violent passions avoided with the utmost care.

I have never seen this course of medicine, with proper regimen, fail to prevent the hydrophobia, and cannot help again observing, that the want of success must generally be owing either to the application of improper medicines, or not using proper ones for a sufficient length of time.

Mankind are extremely fond of every thing that promises a sudden or miraculous cure. By trusting to these they often lose their lives, when a regular course of medicine would have rendered them absolutely safe. This holds remarkably in the present case. Numbers of people, for example, believe if they or their cattle were once dipped in the sea, it is sufficient; as if the salt-water were a charm against the effects of the bite. This, and such like whims, have proved fatal to many.

484It is a common notion, if a person be bit by a dog which is not mad, that, if he should go mad afterwards, the person would be affected with the disorder at the same time; but this notion is too ridiculous to deserve a serious consideration. It is a good rule, however, to avoid dogs as much as possible, as the disease is often upon them for some time before its violent symptoms appear. The hydrophobia has been occasioned by the bite of a dog which shewed no other symptoms of the disease but listlessness and a sullen disposition.

Though we do not mean to treat fully of the cure of the hydrophobia, yet we are far from reckoning it incurable. The notion that this disease could not be cured, has been productive of the most horrid consequences. It was usual either to abandon the unhappy persons, as soon as they were seized with the disease, to their fate, to bleed them to death, or to suffocate them between matrasses or feather-beds, &c. This conduct certainly deserved the severest punishment! We hope, for the honour of human nature, it will never again be heard of.

I have never had an opportunity of treating this disease, and therefore can say nothing of it from my own experience; but the learned Dr. Tissot says, it may be cured in the following manner:

1. The patient must be bled to a considerable quantity; and this may be repeated twice, or thrice, or even a fourth time, if circumstances require it.

2. The patient should be put, if possible, into a warm bath; and this should be used twice a-day.

3. He should every day receive two, or even three emollient clysters.

4. The wound, and the parts adjoining to it, should be rubbed with the mercurial ointment twice a-day.

4855. The whole limb which contains the wound should be rubbed with oil, and be wrapped up in an oily flannel.

6. Every three hours a dose of Cob’s powder should be taken in a cup of the infusion of lime-tree and elder-flowers. This powder is made, by rubbing together in a mortar, to a very fine powder, of native and factitious cinnabar, each twenty-four grains; of musk, sixteen grains^[162].

7. The following bolus is to be given every night, and to be repeated in the morning, if the patient is not easy, washing it down with the infusion mentioned above: Take one drachm of Virginian snake-root in powder; of camphire and asafœtida, ten grains each; of opium, one grain; and, with a sufficient quantity of conserve, or rob of elder, make a bolus.

8. If there be a great nausea at the stomach, with a bitterness in the mouth, thirty-five or forty grains of ipecacuanha, in powder, may be taken for a vomit.

9. The patient’s food, if he takes any, must be light; as panado, soups made of farinaceous or mealy vegetables, &c.

10. If the patient should long continue weak, and subject to terrors, he may take half a drachm of the Peruvian bark thrice a-day.

The next poisonous animal which we shall mention is the VIPER. The grease of this animal rubbed into the wound is said to cure the bite. Though that is all the viper-catchers generally do 486when bit, we should not think it sufficient for the bite of an enraged viper. It would surely be more safe to have the wound well sucked^[163], and afterwards rubbed with warm salad-oil. A poultice of bread and milk, softened with salad-oil, should likewise be applied to the wound; and the patient ought to drink freely of vinegar whey, or water-gruel with vinegar in it, to make him sweat. Vinegar is one of the best medicines which can be used in any kind of poison, and ought to be taken very liberally. If the patient be sick, he may take a vomit. This course will be sufficient to cure the bite of any of the poisonous animals of this country.

With regard to poisonous insects, as the bee, the wasp, the hornet, &c. their stings are seldom attended with danger, unless when a person happens to be stung by a great number of them at the same time; in which case something should be done to abate the inflammation and swelling. Some, for this purpose, apply honey, others lay pounded parsley to the part. A mixture of vinegar and Venice treacle is likewise recommended; but I have always found rubbing the part with warm salad-oil succeed very well. Indeed, when the stings are so numerous as to endanger the patient’s life, which is sometimes the case, he must not only have oily poultices applied to the part, but should likewise 487be bled, and take some cooling medicines, as nitre, or cream of tartar, and should drink plentifully of diluting liquors.

It is the happiness of this island to have very few poisonous animals, and those which we have are by no means of the most virulent kind. Nine-tenths of the effects attributed to poison or venom in this country, are really other diseases, and proceed from quite different causes.

We cannot however make the same observation with regard to poisonous vegetables. These abound every where, and prove often fatal to the ignorant and unwary. This indeed is chiefly owing to carelessness. Children ought early to be cautioned against eating any kind of fruit, roots, or berries, which they do not know, and all poisonous plants to which they can have access, ought, as far as possible, to be destroyed. This would not be so difficult a task as some people imagine.

Poisonous plants have no doubt their use, and they ought to be propagated in proper places; but, as they prove often destructive to cattle, they should be rooted out of all pasture-grounds. They ought likewise, for the safety of the human species, to be destroyed in the neighbourhood of all towns and villages; which, by the bye, are the places where they most commonly abound. I have seen the poisonous hemlock, henbane, wolfsbane, and deadly night-shade, all growing within the environs of a small town, where, though several persons, within the memory of those living in it, had lost their lives by one or other of these plants; yet no method, that I could hear of, had ever been taken to root them out; though this might be done at a very trifling expence.

Seldom a year passes but we have accounts of several persons poisoned by eating hemlock-roots 488instead of parsnips, or some kinds of fungus which they had gathered for mushrooms. These examples ought to put people upon their guard with respect to the former, and to put the latter entirely out of use. Mushrooms may be a delicate dish, but they are a dangerous one, as they are generally gathered by persons who do not know one kind of fungus from another, and take every thing for a mushroom which has that appearance.

We might here mention many other plants and animals of a poisonous nature which are found in foreign countries; but, as our observations are chiefly intended for this island, we shall pass these over. It may not however be amiss to observe, for the benefit of such of our countrymen as go to America, that an effectual remedy is now said to be found for the bite of the rattle-snake.—The prescription is as follows: Take of the roots of plantain and horehound, in summer, roots and branches together, a sufficient quantity; bruise them in a mortar, and squeeze out the juice, of which give, as soon as possible, one large spoonful; if the patient be swelled, you must force it down his throat. This generally will cure; but, if he finds no relief in an hour after, you may give another spoonful, which never fails.—If the roots are dried, they must be moistened with a little water. To the wound may be applied a leaf of good tobacco moistened with rum.

We give this upon the faith of Dr. Brookes, who says it was the invention of a negro; for the discovery of which he had his freedom purchased, and a hundred pounds per annum settled upon him during life, by the General Assembly of Carolina.

It is possible there may be in nature specific remedies for every kind of poison; but as we have very 489little faith in any of those which have yet been pretended to be discovered, we shall beg leave again to recommend the most strict attention to the following rules, viz. That when any poisonous substance has been taken into the stomach, it ought, as soon as possible, to be discharged by vomits, clysters, and purges; and, when poison has been received into the body by a wound, that it be expelled by medicines which promote the different secretions, especially those of sweat, urine, and insensible perspiration; to which may be joined antispasmodics, or such medicines as take off tension and irritation; the chief of which are opium, musk, camphire, and asafœtida.

CHAP. XLVII. OF THE VENEREAL DISEASE.

In the first edition of this book the venereal disease was omitted. The reasons however which at that time induced me to leave it out, have upon more mature consideration vanished. Bad consequences, no doubt, may arise from ignorant persons tampering with medicine in this disorder; but the danger from that quarter seems to be more than balanced by the great and solid advantages, which must arise to the patient from an early knowledge of his case, and an attention to a plan of regimen, which, if it does not cure the disease, will be sure to render it more mild, and less hurtful to the constitution.

It is peculiarly unfortunate for the unhappy persons who contract this disease, that it lies under a sort of disgrace. This renders disguise necessary, 490and makes the patient either conceal his disorder altogether, or apply to those who promise a sudden and secret cure; but who in fact only remove the symptoms for a time, while they fix the disease deeper in the habit. By this means a slight infection, which might have been easily removed, is often converted into an obstinate, and sometimes incurable malady.

Another unfavourable circumstance attending this disease is, that it assumes a variety of different shapes, and may with more propriety be called an assemblage of diseases, than a single one. No two diseases can require a more different method of treatment than this does in its different stages. Hence the folly and danger of trusting to any particular nostrum for the cure of it. Such nostrums are however generally administered in the same manner to all who apply for them, without the least regard to the state of the disease, the constitution of the patient, the degree of infection, and a thousand other circumstances of the utmost importance.

Though the venereal disease is generally the fruit of unlawful embraces, yet it may be communicated to the innocent as well as the guilty. Infants, nurses, midwives, and married women whose husbands lead dissolute lives, are often affected with it, and frequently lose their lives by not being aware of their danger in due time. The unhappy condition of such persons will certainly plead our excuse, if any excuse be necessary, for endeavouring to point out the symptoms and cure of this too common disease.

To enumerate all its different symptoms, however, and to trace the disease minutely through its various stages, would require a much larger space than falls to this part of my subject; I shall therefore confine my observations chiefly to circumstances 491of importance, omitting such as are either trifling, or which occur but seldom. I shall likewise pass over the history of the disease, with the different methods of treatment which it has undergone since it was first introduced into Europe, and many other circumstances of a similar nature; all of which, though they might tend to amuse the reader, yet could afford him little or no useful knowledge.

OF THE VIRULENT GONORRHŒA.

The virulent gonorrhœa is an involuntary discharge of infectious matter from the parts of generation in either sex. It generally makes its appearance within eight or ten days after the infection has been received: sometimes indeed it appears in two or three days, and at other times not before the end of four or five weeks. Previous to the discharge, the patient feels an itching with a small degree of pain in the genitals. Afterwards a thin glary matter begins to distil from the urinary passage, which stains the linen, and occasions a small degree of titillation, particularly in the time of making water; this gradually increasing, arises at length to a degree of heat and pain, which are chiefly perceived about the extremity of the urinary passage, where a slight degree of redness and inflammation likewise begin to appear.

As the disorder advances, the pain, heat of urine, and running, increase, while fresh symptoms daily ensue. In men the erections become painful and involuntary, and are more frequent and lasting than when natural. This symptom is most troublesome when the patient is warm in bed. The pain which was at first only perceived towards the extremity, now begins to reach all 492up the urinary passage, and is most intense just after the patient has done making water. The running gradually recedes from the colour of seed, grows yellow, and at length puts on the appearance of matter.

When the disorder has arrived at its height, all the symptoms are more intense; the heat of urine is so great, that the patient dreads the making water; and though he feels a constant inclination this way, yet it is rendered with the greatest difficulty, and often only by drops: the involuntary erections now become extremely painful and frequent; there is also a pain, heat, and sense of fulness about the seat, and the running is plentiful and sharp, of a brown, greenish, and sometimes of a bloody colour.

By a proper treatment the violence of the symptoms gradually abates; the heat of urine goes off; the involuntary and painful erections, and the heat and pain about the seat, become easier; the running also gradually decreases, grows whiter and thicker, till at last it entirely disappears.

By attending to these symptoms, the gonorrhœa may be generally distinguished from any other disease. There are however some few disorders for which it may be mistaken, as an ulcer in the kidnies or bladder, the fluor albus or whites in women, &c. But in the former of these, the matter comes away only with the urine, or when the sphincter of the bladder is open; whereas in a gonorrhœa, the discharge is constant. The latter is more difficult to distinguish, and must be known chiefly from its effects, as pain, communicating the infection, &c.

REGIMEN.——When a person has reason to suspect that he has caught the venereal infection, he ought most strictly to observe a cooling regimen, to avoid every thing of a heating nature, as wines, 493spirituous liquors, rich sauces, spiced, salted, high-seasoned and smoke-dried provisions, &c. as also all aromatic and stimulating vegetables, as onions, garlic, shallot, nutmeg, mustard, cinnamon, mace, ginger, and such like. His food ought chiefly to consist of mild vegetables, milk, broths, light puddings, panado, gruels, &c. His drink may be barley-water, milk and water, decoctions of marsh-mallows and liquorice, linseed-tea, or clear whey. Of these he ought to drink plentifully. Violent exercise of all kinds, especially riding on horseback, and venereal pleasures, are to be avoided. The patient must beware of cold, and when the inflammation is violent, he ought to keep his bed.

MEDICINE.——A virulent gonorrhœa cannot always be cured speedily and effectually at the same time. The patient ought therefore not to expect, nor the physician to promise it. It will often continue for two or three weeks, and sometimes for five or six, even where the treatment has been very proper.

Sometimes indeed a slight infection may be carried off in a few days, by bathing the parts in warm milk and water, and injecting frequently up the urethra a little sweet oil or linseed-tea about the warmth of new milk. Should these not succeed in carrying off the infection, they will at least have a tendency to lessen its virulence.

To effect a cure, however, astringent injections will generally be found necessary. These may be various ways prepared, but I think those made with the white vitriol are both most safe and efficacious. They can be made stronger or weaker as circumstances may require; but it is best to begin with the more gentle, and increase their power if necessary. I generally order a drachm of white vitriol to be dissolved in eight or nine ounces of 494common or rose-water, and an ordinary syringe full of it to be thrown up three or four times a-day. If this quantity does not perform a cure, it may be repeated, and the dose increased^[164].

Whether injections be used or not, cooling purges are always proper in the gonorrhœa. They ought not however to be of the strong or drastic kind. Whatever raises a violent commotion in the body increases the danger, and tends to drive the disease deeper into the habit. Procuring two or three stools every second or third day for the first fortnight, and the same number every fourth or fifth day for the second, will generally be sufficient to remove the inflammatory symptoms, to diminish the running, and to change its colour and consistence. It gradually becomes more white and ropy as the virulence abates^[165].

495When the inflammatory symptoms run high, bleeding is always necessary at the beginning. This operation, as in other topical inflammations, must be repeated according to the strength and constitution of the patient, and the vehemence and urgency of the symptoms.

Medicines which promote the secretion of urine, are likewise proper in this stage of the disorder. For this purpose, an ounce of nitre and two ounces of gum-arabic, pounded together, may be divided into twenty-four doses, one of which may be taken frequently in a cup of the patient’s drink. If these should make him pass his urine so often as to become troublesome to him, he may either take them less frequently, or leave out the nitre altogether, and take equal parts of gum-arabic and cream of tartar. These may be pounded together, and a tea-spoonful taken in a cup of the patient’s drink four or five times a-day. I have generally found this answer extremely well both as a diuretic, and for keeping the body gently open.

When the pain and inflammation are seated high towards the neck of the bladder, it will be proper frequently to throw up an emollient clyster, which, besides the benefit of procuring stools, will serve as a fomentation to the inflamed parts.

496Soft poultices, when they can conveniently be applied to the parts, are of great service. They may be made of the flour of linseed, or of wheat-bread and milk, softened with fresh butter or sweet oil. When poultices cannot be conveniently used, cloths wrung out of warm water, or bladders filled with warm milk and water, may be applied. I have often known the most excruciating pains, during the inflammatory state of the gonorrhœa, relieved by one or other of these applications.

Few things tend more to keep off inflammation in the spermatic vessels, than a proper truss for the scrotum. It ought to be so contrived as to support the testicles, and should be worn from the first appearance of the disease till it has ceased some weeks.

The above treatment will sometimes remove the gonorrhœa so quickly, that the person will be in doubt whether he really laboured under that disease. This, however, is too favourable a turn to be often expected. It more frequently happens, that we are able only to procure an abatement or remission of the inflammatory symptoms, so far as to make it safe to have recourse to the great antidote mercury.

Many people, on the first appearance of a gonorrhœa, fly to the use of mercury. This is a bad plan. Mercury is often not at all necessary in a gonorrhœa; and when taken too early, it does mischief. It may be necessary to complete the cure, but can never be proper at the commencement of it.

When bleeding, purging, fomentations, and the other things recommended above, have eased the pain, softened the pulse, relieved the heat of urine, and rendered the involuntary erections less frequent, the patient may begin to use mercury in any form that is least disagreeable to him.

497If he takes the common mercurial pill, two at night and one in the morning will be a sufficient dose at first. Should they affect the mouth too much, the dose must be lessened; if not at all, it may be gradually increased to five or six pills in the day. If calomel be thought preferable, two or three grains of it, formed into a bolus with a little of the conserve of hips, may be taken at bed-time, and the dose gradually increased to eight or ten grains. One of the most common preparations of mercury now in use is the corrosive sublimate. This may be taken in the manner afterwards recommended under the confirmed lues or pox. I have always found it one of the most safe and efficacious medicines when properly used.

The above medicines may either be taken every day or every other day, as the patient is able to bear them. They ought never to be taken in such quantity as to raise a salivation, unless in a very slight degree. The disease may be more safely, and as certainly, cured without a salivation as with it. When the mercury runs off by the mouth, it is not so successful in carrying off the disease, as when it continues longer in the body, and is discharged gradually.

Should the patient be purged or griped in the night by the mercury, he must take an infusion of senna, or some other purgative, and drink freely of water-gruel to prevent bloody stools, which are very apt to happen should the patient catch cold, or if the mercury has not been duly prepared. When the bowels are weak and the mercury is apt to gripe or purge, these disagreeable consequences may be prevented by taking, with the above pills or bolus, half a drachm or two scruples of diascordium, or of the Japonic confection.

To prevent the disagreeable circumstance of the mercury’s affecting the mouth too much, or bringing 498on a salivation, it may be combined with purgatives. With this view the laxative mercurial pill has been contrived, the usual dose of which is half a drachm, or three pills, night and morning, to be repeated every other day; but the safer way is for the patient to begin with two, or even with one pill, gradually increasing the dose.

To such persons as can neither swallow a bolus nor a pill, mercury may be given in a liquid form, as it can be suspended even in a watery vehicle, by means of gum-arabic; which not only serves this purpose, but likewise prevents the mercury from affecting the mouth, and renders it in many respects a better medicine^[166].

It happens very fortunately for those who cannot be brought to take mercury inwardly, and likewise for persons whose bowels are too tender to bear it, that an external application of it will answer equally well, and in some respects better. It must be acknowledged, that mercury, taken inwardly for any length of time, greatly weakens and disorders the bowels; for which reason, when a plentiful use of it becomes necessary, we would prefer rubbing to the mercurial pills. The common mercurial or blue ointment will answer very well. Of that which is made by rubbing together equal quantities of hog’s lard and quicksilver, about a drachm may be used at a time. The best time for rubbing it on is at night, and the most proper place 499the inner side of the thighs. The patient should stand before the fire when he rubs, and should wear flannel drawers next his skin at the time he is using the ointment. If ointment of a weaker or stronger kind be used, the quantity must be increased or diminished in proportion.

If, during the use of the ointment, the inflammation of the genital parts, together with the heat and feverishness, should return, or if the mouth should grow sore, the gums tender, and the breath become offensive, a dose or two of Glauber’s salts, or some other cooling purge, may be taken, and the rubbing intermitted for a few days. As soon, however, as the signs of spitting are gone off, if the virulency be not quite corrected, the ointment must be repeated, but in smaller quantities, and at longer intervals than before. Whatever way mercury is administered, its use must be persisted in as long as any virulency is suspected to remain.

During this, which may be called the second stage of the disorder, though so strict a regimen is not necessary as in the first or inflammatory state, yet intemperance of every kind must be avoided. The food must be light, plain, and of easy digestion; and the greatest indulgence that may be allowed with respect to drink is, a little wine diluted with a sufficient quantity of water. Spirituous liquors are to be avoided in every shape. I have often known the inflammatory symptoms renewed and heightened, the running increased, and the cure rendered extremely difficult and tedious, by one fit of excessive drinking.

When the above treatment has removed the heat of urine, and soreness of the genital parts; when the quantity of running is considerably lessened, without any pain or swelling in the groin or testicle supervening; when the patient is free from involuntary erections; and lastly, when the running 500becomes pale, whitish, thick, void of ill smell, and tenacious or ropy; when all or most of these symptoms appear, the gonorrhœa is arrived at its last stage, and we may gradually proceed to treat it as a gleet with astringent and agglutinating medicines.

OF GLEETS.

A gonorrhœa frequently repeated, or improperly treated, often ends in a gleet, which may either proceed from relaxation, or from some remains of the disease. It is however of the greatest importance in the cure of the gleet, to know from which of these causes it proceeds. When the discharge proves very obstinate, and receives little or no check from astringent remedies, there is ground to suspect that it is owing to the latter; but if the drain is inconstant, and is chiefly observable when the patient is stimulated by lascivious ideas, or upon straining to go to stool, we may reasonably conclude that it is chiefly owing to the former.

In the cure of a gleet proceeding from relaxation, the principal design is to brace, and restore a proper degree of tension to the debilitated and relaxed vessels. For this purpose, besides the medicines recommended in the gonorrhœa, the patient may have recourse to stronger and more powerful astringents, as the Peruvian bark^[167], alum, vitriol, 501galls, tormentil, bistort, baldustines, tincture of gum kino, &c. The injections may be rendered more astringent by the addition of a few grains of alum, or increasing the quantity of vitriol as far as the parts are able to bear it.

The last remedy which we shall mention in this case is the cold bath, than which there is not perhaps a more powerful bracer in the whole compass of medicine. It ought never to be omitted in this species of gleet, unless there be something in the constitution of the patient which renders the use of it unsafe. The chief objections to the use of the cold bath are, a full habit, and an unsound state of the viscera. The danger from the former may always be lessened, if not removed, by purging and bleeding; but the latter is an insurmountable obstacle, as the pressure of the water, and the sudden contraction of the external vessels, by throwing the blood with too much force upon the internal parts, are apt to occasion ruptures of the vessels, or a flux of humours upon the diseased organs. But where no objection of this kind prevails, the patient ought to plunge over head in water every morning fasting, for three or four weeks together. He should not however stay long in the water, and should take care to have his skin dried as soon as he comes out.

The regimen proper in this case is the same as was mentioned in the last stage of the gonorrhœa: the diet must be drying and astringent, and the drink Spa, Pyrmont, or Bristol waters, with which a little claret or red wine may sometimes be mixed. Any person may now afford to drink these waters, as they can be every where prepared at almost no expence, by a mixture of common chalk and oil of vitriol.

When the gleet does not in the smallest degree yield to these medicines, there is reason to suspect 502that it proceeds from ulcers. In this case recourse must be had to mercury, and such medicines as tend to correct any predominant acrimony with which the juices may be affected, as the decoction of China, sarsaparilla, sassafras, or the like.

Mr. Fordyce says, he has seen many obstinate gleets of two, three, or four years standing, effectually cured by a mercurial inunction, when almost every other medicine has been tried in vain. Dr. Chapman seems to be of the same opinion; but says, he has always found the mercury succeed best in this case when joined with terebinthinate and other agglutinating medicines. For which reason the Doctor recommends pills made of calomel and Venice turpentine^[168]; and desires that their use may be accompanied with a decoction of guaiacum or sarsaparilla.

The last kind of remedy which we shall mention for the cure of ulcers in the urinary passage, are the suppurating candles or bougies: as these are prepared various ways, and are generally to be bought ready made, it is needless to spend time in enumerating the different ingredients of which they are composed, or teaching the manner of preparing them. Before a bougie be introduced into the urethra, however, it should be smeared all over with sweet oil, to prevent it from stimulating too suddenly; it may be suffered to continue in from one to seven or eight hours, according as the patient can bear it. Obstinate ulcers are not only often healed, but tumours and excrescences in the 503urinary passages taken away, and an obstruction of urine removed by means of bougies. Obstinate gleets may be removed by the use of bougies.

OF THE SWELLED TESTICLE.

The swelled testicle may either proceed from infection lately contracted, or from the venereal poison lurking in the blood: the latter indeed is not very common, but the former frequently happens both in the first and second stages of a gonorrhœa; particularly when the running is unseasonably checked, by cold, hard drinking, strong drastic purges, violent exercise, the too early use of astringent medicines, or the like.

In the inflammatory stage bleeding is necessary, which must be repeated according to the urgency of the symptoms^[169]. The food must be light, and the drink diluting. High-seasoned food, flesh, wines, and every thing of a heating nature, are to be avoided. Fomentations are of singular service. Poultices of bread and milk, softened with fresh butter or oil, are likewise very proper, and ought constantly to be applied when the patient is in bed: when he is up, the testicles should be kept warm, and supported by a bag or truss, which may easily be contrived in such a manner as to prevent the weight of the testicle from having any effect.

If it should be found impracticable to clear the testicle by the cooling regimen now pointed out, and extended according to circumstances, it will be necessary to lead the patient through such a complete antivenereal course as shall ensure him against any future uneasiness. For this purpose, besides rubbing the mercurial ointment on the part, if free 504from pain, or on the thighs, as directed in the gonorrhœa, the patient must be confined to bed, if necessary, for five or six weeks, suspending the testicle all the while with a bag or truss, and plying him inwardly with strong decoctions of sarsaparilla.

When these means do not succeed, and there is reason to suspect a scrophulous or cancerous habit, either of which may support a scirrhous induration, after the venereal poison is corrected, the parts should be fomented daily with a decoction of hemlock, the bruised leaves of which may likewise be added to the poultice, and the extract at the same time taken inwardly^[170]. This practice is strongly recommended by Dr. Stork in scirrhous and cancerous cases; and Mr. Fordyce assures us, that by this method he has cured diseased testicles of two or three years standing, even when ulcerated, and when the scirrhus had begun to be affected with pricking and lancing pains.

OF BUBOES.

Venereal buboes are hard tumours seated in the groin, occasioned by the venereal poison lodged in this part. They are of two kinds; viz. such as proceed from a recent infection, and such as accompany a confirmed lues.

The cure of recent buboes, that is, such as appear soon after impure coition, may be first attempted by dispersion, and, if that should not succeed, by suppuration. To promote the dispersion of a bubo, the same regimen must be observed as was directed in the first stage of a gonorrhœa. The patient must likewise be bled, and take some cooling 505purges, as the decoction of tamarinds and senna, Glauber’s salts, and the like. If, by this course, the swelling and other inflammatory symptoms abate, we may safely proceed to the use of mercury, which must be continued till the venereal virus is quite subdued^[171].

But if the bubo should, from the beginning, be attended with great heat, pain, and pulsation, it will be proper to promote its suppuration. For this purpose the patient may be allowed to use his ordinary diet, and to take now and then a glass of wine. Emollient cataplasms, consisting of bread and milk softened with oil or fresh butter, may be applied to the part; and, in cold constitutions, where the tumour advances slowly, white lily-roots boiled, or sliced onions raw, and a sufficient quantity of yellow basilicon, may be added to the poultice.

When the tumour is ripe, which may be known by its conical figure, the softness of the skin, and a fluctuation of matter plainly to be felt under the finger, it may be opened either by a caustic or a lancet, and afterwards dressed with digestive ointment.

It sometimes however happens, that buboes can neither be dispersed nor brought to a suppuration, but remain hard, indolent tumours. In this case the indurated glands must be consumed by caustic; if they should become scirrhous, they must be dissolved by the application of hemlock, both externally and internally, as directed in the scirrhous testicle.

506

OF CHANCRES.

Chancres are superficial, callous, eating ulcers; which may happen either with or without a gonorrhœa. They are commonly seated about the glans, and make their appearance in the following manner: First a little red pimple arises, which soon becomes pointed at top, and is filled with a whitish matter inclining to yellow. This pimple is hot, and itches generally before it breaks: afterwards it degenerates into an obstinate ulcer, the bottom of which is usually covered with a viscid mucus, and whose edges gradually become hard and callous. Sometimes the first appearance resembles a simple excoriation of the cuticle; which however, if the cause be venereal, soon becomes a true chancre.

A chancre is sometimes a primary affection, but it is much oftner symptomatic, and is the mark of a confirmed lues. Primary chancres discover themselves soon after impure coition, and are generally seated in parts covered with a thin cuticle, as the lips, the nipples of women, the glans penis of men, &c.^[172].

When a chancre appears soon after impure coition, its treatment is nearly similar to that of the virulent gonorrhœa. The patient must observe the cooling regimen, lose a little blood, and take some gentle doses of salts and manna. The parts affected 507ought frequently to be bathed, or rather soaked, in warm milk and water, and, if the inflammation be great, an emollient poultice or cataplasm may be applied to them. This course will, in most cases, be sufficient to abate the inflammation, and prepare the patient for the use of mercury.

Symptomatic chancres are commonly accompanied with ulcers in the throat, nocturnal pains, scurfy eruptions about the roots of the hair, and other symptoms of a confirmed lues. Though they may be seated in any of the parts mentioned above, they commonly appear upon the private parts, or the inside of the thigh. They are also less painful, but frequently much larger and harder than primary chancres. As their cure must depend upon that of the pox, of which they are only a symptom, we shall take no further notice of them, till we come to treat of a confirmed lues^[173].

Thus we have related most of the symptoms which accompany or succeed a violent gonorrhœa, and have also given a short view of their proper treatment; there are, however, several others which sometimes attend this disease, as a strangury or obstruction of urine, phymosis, paraphymosis, &c.

A strangury may be occasioned either by a spasmodic constriction, or an inflammation of the urethra and parts about the neck of the bladder. In the former case, the patient begins to void his urine with tolerable ease; but, as soon as it touches the galled or inflamed urethra, a sudden constriction takes place, and the urine is voided by spurts, and sometimes by drops only. When the strangury is 508owing to an inflammation about the neck of the bladder, there is a constant heat and uneasiness of the part, a perpetual desire to make water, while the patient can only render a few drops, and a troublesome tenesmus, or constant inclination to go to stool.

When the strangury is owing to spasm, such medicines as tend to dilute and blunt the salts of the urine will be proper. For this purpose, besides the common diluting liquors, soft and cooling emulsions, sweetened with the syrup of poppies, may be used. Should these not have the desired effect, bleeding, and emollient fomentations, will be necessary.

When the complaint is evidently owing to an inflammation about the neck of the bladder, bleeding must be more liberally performed, and repeated according to the urgency of the symptoms. After bleeding, if the strangury still continues, soft clysters, with a proper quantity of laudanum in them, may be administered, and emollient fomentations applied to the region of the bladder. At the same time, the patient may take every four hours a tea-cupful of barley-water, to an English pint of which six ounces of the syrup of marsh-mallows, four ounces of the oil of sweet almonds, and half an ounce of nitre, may be added. If these remedies should not relieve the complaint, and a total suppression of urine should come on, bleeding must be repeated, and the patient set in a warm bath up to the middle. It will be proper in this case to discontinue the diuretics, and to draw off the water with a catheter; but as the patient is seldom able to bear its being introduced, we would rather recommend the use of mild bougies. These often lubricate the passage, and greatly facilitate the discharge of urine. Whenever they begin to 509stimulate or give any uneasiness, they may be withdrawn.

The phymosis is such a constriction of the prepuce over the glans, as hinders it from being drawn backwards; the paraphymosis, on the contrary, is such a constriction of the prepuce behind the glans, as hinders it from being brought forward.

The treatment of these symptoms is so nearly the same with that of the virulent gonorrhœa, that we have no occasion to enlarge upon it. In general, bleeding, purging, poultices, and emollient fomentations are sufficient. Should these, however, fail of removing the stricture, and the parts be threatened with a mortification, twenty or thirty grains of ipecacuanha, and one grain of emetic tartar, may be given for a vomit, and may be worked off with warm water or thin gruel.

It sometimes happens, that, in spite of all endeavours to the contrary, the inflammation goes on, and symptoms of a beginning mortification appear. When this is the case, the prepuce must be scarified with a lancet, and, if necessary, divided, in order to prevent a strangulation, and set the imprisoned glans at liberty. We shall not describe the manner of performing this operation, as it ought always to be done by a surgeon. When a mortification has actually taken place, it will be necessary, besides performing the above operations, to foment the parts frequently with cloths wrung out of a strong decoction of camomile-flowers and bark, and to give the patient a drachm of the bark in powder every two or three hours.

With regard to the priapism, chordee, and other distortions of the penis, their treatment is no way different from that of the gonorrhœa. When they prove very troublesome, the patient may take a few drops of laudanum at night, especially after the operation of a purgative through the day.

510

OF A CONFIRMED LUES.

We have hitherto treated of those affections in which the venereal poison is supposed to be confined chiefly to the particular part by which it was received, and shall next take a view of the lues in its confirmed state; that is, when the poison is actually received into the blood, and, circulating with it through every part of the body, mixes with the several secretions, and renders the whole habit tainted.

The symptoms of a confirmed lues are, buboes in the groin, pains of the head and joints, which are peculiarly troublesome in the night, or when the patient is warm in bed; scabs and scurfs in various parts of the body, especially on the head, of a yellowish colour, resembling a honey-comb; corroding ulcers in various parts of the body, which generally begin about the throat, from whence they creep gradually, by the palate, towards the cartilage of the nose, which they destroy; excrescences or exostoses arise in the middle of the bones, and their spongy ends become brittle, and break upon the least accident; at other times they are soft, and bend like wax; the conglobate glands become hard and callous, and form, in the neck, armpits, groin, and mesentery, hard moveable tumours, like the king’s evil; tumours of different kinds are likewise formed in the lymphatic vessels, tendons, ligaments, and nerves, as the gummata, ganglia, nodes, tophs, &c.; the eyes are affected with itching, pain, redness, and sometimes with total blindness, and the ears with a singing noise, pain, and deafness, whilst their internal substance is exulcerated and rendered carious; at length all the animal, vital, 511and natural functions are depraved; the face becomes pale and livid; the body emaciated and unfit for motion, and the miserable patient falls into an atrophy or wasting consumption.

Women have symptoms peculiar to the sex; as cancers of the breast; a suppression or overflowing of the menses; the whites; hysteric affections; an inflammation, abscess, scirrhus, gangrene, cancer, or ulcer of the womb; they are generally either barren or subject to abortion; or, if they bring children into the world, they have an universal erysipelas, are half rotten, and covered with ulcers.

Such is the catalogue of symptoms attending this dreadful disease in its confirmed state. Indeed they are seldom all to be met with in the same person, or at the same time; so many of them, however, are generally present as are sufficient to alarm the patient; and if he has reason to suspect the infection is lurking in his body, he ought immediately to set about the expulsion of it, otherwise the most tragical consequences will ensue.

The only certain remedy hitherto known in Europe, for the cure of this disease, is mercury, which may be used in a great variety of forms, with nearly the same success. Some time ago it was reckoned impossible to cure a confirmed lues without a salivation. This method is now however pretty generally laid aside, and mercury is found to be as efficacious, or rather more so, in expelling the venereal poison, when administered in such a manner as not to run off by the salivary glands.

Though many are of opinion, that the mercurial ointment is as efficacious as any other preparation of that mineral; yet experience has taught me to think otherwise. I have often seen the most obstinate venereal cases, where great quantities of mercurial ointment had been used in vain, yield to the saline preparations of mercury. Nor am I singular 512in this opinion. My ingenious friend, Mr. Clare, an eminent surgeon of this city, assures me, that for some time past he has employed, in venereal cases, a saline preparation of mercury with most happy success. This preparation, rubbed with a sufficient quantity of any mild powder, he applies, in small portions, to the tongue, where, with a gentle degree of friction, it is immediately absorbed, and produces its full effect; upon the system, without doing the least injury to the stomach or bowels; a matter of the greatest importance in the application of this most active and powerful remedy.

It is impossible to ascertain either the exact quantity of medicines that must be taken, or the time they ought to be continued, in order to perform a cure. These will ever vary according to the constitution of the patient, the season of the year, the degree of infection, the time it has lodged in the body, &c. But though it is difficult, as Astruc observes, to determine à priori, what quantity of mercury will, in the whole, be necessary to cure this distemper completely; yet it may be judged of à posteriori, from the abatement and ceasing of the symptoms. The same author adds, that commonly not less than two ounces of the strong mercurial ointment is sufficient, and not more than three or four ounces necessary.

The only chemical preparation of mercury which we shall take notice of, is the corrosive sublimate. This was some time ago brought into use for the venereal disease, in Germany, by the illustrious Baron Van Swieten; and was soon after introduced into Britain by the learned Sir John Pringle, at that time physician to the army. The method of giving it is as follows: One grain of corrosive sublimate is dissolved in two ounces of French brandy or malt spirits; and of this solution, 513an ordinary table-spoonful, or the quantity of half an ounce, is to be taken twice a-day, and to be continued as long as any symptoms of the disorder remain. To those whose stomach cannot bear the solution, the sublimate may be given in form of pill^[174].

Several roots, woods, and barks, have been recommended for curing the venereal disease; but none of them have been found, upon experience, to answer the high encomiums which had been bestowed upon them. Though no one of these is to be depended upon alone, yet, when joined with mercury, some of them are found to be very beneficial in promoting a cure. One of the best we know yet is sarsaparilla, which may be prepared and taken according to the directions in the Appendix^[175].

The mezereon root is likewise found to be a powerful assistant to the sublimate, or any other mercurial. It may either be used along with the sarsaparilla, as directed in the Appendix, or by itself. Those who chuse to use the mezereon by itself, may boil an ounce of the fresh bark, taken from the root, in twelve English pints of water to eight, adding towards the end an ounce of liquorice. The dose of this is the same as of the decoction of sarsaparilla.

We have been told that the natives of America cure the venereal disease, in every stage, by a decoction 514of the root of a plant called the Lobelia. It is used either fresh or dried; but we have no certain accounts with regard to the proportion. Sometimes they mix other roots with it, as those of the ranunculus, the ceanothus, &c.; but whether these are designed to disguise or assist it, is doubtful. The patient takes a large draught of the decoction early in the morning, and continues to use it for his ordinary drink through the day^[176].

Many other roots and woods might be mentioned which have been extolled for curing the venereal disease, as the china-root, the roots of soap-wort, burdock, &c. as also the wood of guaiacum and sassafras; but as none of these have been found to possess virtues superior to those already mentioned, we shall, for the sake of brevity, pass them over, and shall conclude our observations on this disease with a few general remarks concerning the proper management of the patient, and the nature of the infection.

515

GENERAL OBSERVATIONS.

The condition of the patient ought always to be considered previous to his entering upon a course of mercury in any form. It would be equally rash and dangerous to administer mercury to a person labouring under any violent acute disease, as a putrid fever, pleurisy, peripneumony, or the like. It would likewise be dangerous in some chronic cases; as a slow hectic fever, or the last stage of a consumption. Sometimes, however, these diseases proceed from a confirmed lues; in which case it will be necessary to give mercury. In chronic diseases of a less dangerous nature, as the asthma, the gravel, and such like, mercury, if necessary, may be safely administered. If the patient’s strength has been greatly exhausted by sickness, labour, abstinence, or any other cause, the use of mercury must be postponed, till by time, rest, and a nourishing diet, it can be sufficiently restored.

Mercury ought not to be administered to women during the menstrual flux, or when the period is near at hand. Neither should it be given in the last stage of pregnancy. If, however, the woman be not near the time of her delivery, and circumstances render it necessary, mercury may be given, but in smaller doses, and at greater intervals than usual: with these precautions, both the mother and child may be cured at the same time; if not, the disorder will at least be kept from growing worse, till the woman be brought to bed, and sufficiently recovered, when a more effectual method may be pursued, which, if she suckles her child, will in all probability be sufficient for the cure of both.

516Mercury ought always to be administered to infants with the greatest caution. Their tender condition unfits them for supporting a salivation, and makes it necessary to administer even the mildest preparations of mercury to them with a sparing hand. A similar conduct is recommended in the treatment of old persons, who have the misfortune to labour under a confirmed lues. No doubt the infirmities of age must render people less able to undergo the fatigues of a salivation; but this, as was formerly observed, is never necessary; besides, we have generally found, that mercury had much less effect upon very old persons than on those who were younger.

Hysteric and hypochondriac persons, and such as are subject to an habitual diarrhœa or dysentery, or to frequent and violent attacks of the epilepsy, or who are afflicted with the scrophula, or the scurvy, ought to be cautious in the use of mercury. Where any one of these disorders prevails, it ought either, if possible, to be cured, or at least palliated, before the patient enters upon a course of mercury. When this cannot be done, the mercury must be administered in smaller doses, and at longer intervals than usual.

The most proper seasons for entering upon a course of mercury, are the spring and autumn, when the air is of a moderate warmth. If the circumstances of the case, however, will not admit of delay, we must not defer the cure on account of the season, but must administer the mercury; taking care at the same time to keep the patient’s chamber warmer or cooler, according as the season of the year requires.

The next thing to be considered is the preparation necessary to be observed before we proceed to administer a course of mercury. Some lay great 517stress upon this circumstance, observing, that by previously relaxing the vessels, and correcting any disorder which may happen to prevail in the blood, not only the mercury will be disposed to act more kindly, but many other inconveniencies will be prevented.

We have already recommended bleeding and gentle purges, previous to the administration of mercury, and shall only now add, that these are always to be repeated according to the age, strength, constitution, and other circumstances of the patient. Afterwards, if it can be conveniently done, the patient ought to bathe once or twice a-day, for a few days, in lukewarm water. His diet in the mean time must be light, moist, and cooling. Wine, and all heating liquors, also violent bodily exercise, and all great exertions of the mind, are carefully to be avoided.

A proper regimen is likewise to be observed by such as are under a course of mercury. Inattention to this not only endangers the patient’s life but often also disappoints him of a cure. A much smaller quantity of mercury will be sufficient for the cure of a person who lives low, keeps warm, and avoids all manner of excess, than of one who cannot endure to put the smallest restraint upon his appetites: indeed it but rarely happens that such are thoroughly cured.

There is hardly any thing of more importance, either for preventing or removing venereal infection than cleanliness. By an early attention to this, the infection might often be prevented from entering the body; and, where it has already taken place, its effects may be greatly mitigated. The moment any person has reason to suspect that he has received the infection, he ought to wash the parts with water and spirits, sweet oil, or milk and water; a small quantity of the last may likewise be 518injected up the urethra, if it can be conveniently done. Whether this disease at first took its rise from dirtiness is hard to say; but wherever that prevails, the infection is found in its greatest degree of virulence, which gives ground to believe that a strict attention to cleanliness would go far towards extirpating it altogether^[177].

When the venereal disease has been neglected, or improperly treated, it often becomes a disorder of the habit. In this case the cure must be attempted by restoratives, as a milk diet, the decoction of sarsaparilla, and such like, to which mercury may be occasionally added. It is a common practice in North Britain to send such patients to drink goat-whey. This is a very proper plan, provided the 519infection has been totally eradicated before-hand; but when that is not the case, and the patient trusts to the whey for finishing his cure, he will often be disappointed. I have frequently known the disease return with all its virulence after a course of goat-whey, even when that course had been thought quite sufficient for completing the cure.

One of the most unfortunate circumstances attending patients in this disease, is the necessity they are often laid under of being soon well. This induces them to take medicine too fast, and to leave it off too soon. A few grains more of medicine, or a few days longer confinement, would often be sufficient to perfect the cure; whereas, by neglect of these, a small degree of virulence is still left in the humours, which gradually vitiates, and at length contaminates the whole mass. To avoid this, we would advise, that the patient should never leave off taking medicine immediately upon the disappearing of the symptoms, but continue it for some time after, gradually lessening the quantity, till there is sufficient ground to believe that the disease is entirely eradicated.

It is not only difficult, but absolutely impossible, to ascertain the exact degree of virulence that may attend the disease; for which reason it will always be a much safer rule to continue the use of medicine too long, than to leave it off too soon. This seems to be the leading maxim of a modern practitioner of some note for the venereal disease, who always orders his patient to perform a quarantine of at least forty days, during which time he takes forty bottles of, I suppose, a strong decoction of sarsaparilla, or some other antivenereal simple. Whoever takes this method, and adds a sufficient quantity of corrosive sublimate, or some other active preparation of mercury to the decoction, will seldom fail to cure a confirmed lues.

520It is peculiarly unfortunate for the cure of this disease, that not one in ten of those who contract it, are either able or willing to submit to a proper plan of regimen. The patient is willing to take medicine; but he must follow his business, and, to prevent suspicions, must eat and drink like the rest of the family. This is the true source of nine-tenths of all the mischief arising from the venereal disease. I never knew the cure attended with any great difficulty or danger where the patient strictly followed the physician’s advice: but a volume would not be sufficient to point out the dreadful consequences which proceed from an opposite conduct. Scirrhous testicles, ulcerous sore throats, madness, consumptions, carious bones, and a rotten progeny, are a few of the blessings derived from this source.

There is a species of false reasoning, with regard to this disease, which proves fatal to many. A person of a sound constitution contracts a slight degree of the disorder. He gets well without taking any great care, or using much medicine, and hence concludes that this will always be the case. The next time the disease occurs, though, ten times more virulent, he pursues the same course, and his constitution is ruined. Indeed, the different degrees of virulence in the small-pox are not greater than in this disease, though, as the learned Sydenham observes, in some cases the most skilful physicians cannot cure, and in others the most ignorant old woman cannot kill the patient in that disorder. Though a good constitution is always in favour of the patient, yet too great stress may be laid upon it. It does not appear from observation, that the most robust constitution is able to overcome the virulence of the venereal contagion, after it has got into the habit. In this case a proper 521course of medicine is always indispensably necessary.

Although it is impossible, on account of the different degrees of virulence, &c. to lay down fixed and certain rules for the cure of this disease, yet the following general plan will always be found safe, and often successful, viz. to bleed and administer gentle purges with diuretics during the inflammatory state, and as soon as the symptoms of inflammation are abated, to administer mercury, in any form that may be most agreeable to the patient. The same medicine, assisted by the decoction of sarsaparilla, and a proper regimen, will not only secure the constitution against the further progress of a confirmed pox, but will generally perform a complete cure.

CHAP. XLVIII. DISEASES OF WOMEN.

Women, in all civilized nations, have the management of domestic affairs, and it is very proper they should, as Nature has made them less fit for the more active and laborious employments. This indulgence, however, is generally carried too far; and females, instead of being benefited by it, are greatly injured, from the want of exercise and free air. To be satisfied of this, one need only compare the fresh and ruddy looks of a milk-maid, with the pale complexion of those females whose whole time is spent within doors. Though Nature has made an evident distinction between the male and female with regard to bodily strength and vigour, yet she certainly never meant, either that 522the one should be always without, or the other always within doors.

The confinement of females, besides hurting their figure and complexion, relaxes their solids, weakens their minds, and disorders all the functions of the body. Hence proceed obstructions, indigestion, flatulence, abortions, and the whole train of nervous disorders. These not only unfit women for being mothers and nurses, but often render them whimsical and ridiculous. A sound mind depends so much upon a healthy body, that where the latter is wanting the former is rarely to be found.

I have always observed, that women who were chiefly employed without doors, in the different branches of husbandry, gardening, and the like, were almost as hardy as their husbands, and that their children were likewise strong and healthy. But as the bad effects of confinement and inactivity upon both sexes have been already shewn, we shall proceed to point out those circumstances in the structure and design of females, which subject them to peculiar diseases; the chief of which are, their monthly evacuations, pregnancy, and child-bearing. These indeed cannot properly be called diseases, but from the delicacy of the sex, and their being often improperly managed in such situations, they become the source of numerous calamities.

OF THE MENSTRUAL DISCHARGE.

Females generally begin to menstruate about the age of fifteen, and leave it off about fifty, which renders these two periods the most critical of their lives. About the first appearance of this discharge, the constitution undergoes a very considerable change, generally indeed for the better, though 523sometimes for the worse. The greatest care is now necessary, as the future health and happiness of the female depends in a great measure upon her conduct at this period^[178].

If a girl about this time of life be confined to the house, kept constantly sitting, and neither allowed to romp about, nor employed in any active business, which gives exercise to the whole body, she becomes weak, relaxed, and puny; her blood not being duly prepared, she looks pale and wan; her health, spirits, and vigour decline, and she sinks into a valetudinarian for life. Such is the fate of numbers of those unhappy females, who, either from too much indulgence, or their own narrow circumstances, are, at this critical period, denied the benefit of exercise and free air.

A lazy indolent disposition proves likewise very hurtful to girls at this period. One seldom meets with complaints from obstructions amongst the more active and industrious part of the sex; whereas the indolent and lazy are seldom free from them. These are in a manner eaten up by the chlorosis, or green-sickness, and other diseases of this nature. We would therefore recommend it to all who wish to escape these calamities, to avoid indolence and inactivity, as their greatest enemies, and to be as much abroad in the open air as possible.

524Another thing which proves very hurtful to girls about this period of life, is unwholesome food. Fond of all manner of trash, they often indulge in it, till their whole humours are quite vitiated. Hence ensue indigestions, want of appetite, and a numerous train of evils. If the fluids be not duly prepared, it is utterly impossible that the secretions should go properly on. Accordingly we find, that such girls as lead an indolent life, and eat great quantities of trash, are not only subject to obstructions of the menses, but likewise to glandular obstructions; as the scrophula, or king’s evil, &c.

A dull disposition is also very hurtful to girls at this period. It is a rare thing to see a sprightly girl who does not enjoy good health, while the grave, moping, melancholy creature, proves the very prey of vapours and hysterics. Youth is the season for mirth and cheerfulness. Let it therefore be indulged. It is an absolute duty. To lay in a stock of health in time of youth, is as necessary a piece of prudence, as to make provision against the decays of old age. While, therefore, wise Nature prompts the happy youth to join in sprightly amusements, let not the severe dictates of hoary age forbid the useful impulse, nor damp, with serious gloom, the season destined to mirth and innocent festivity.

Another thing very hurtful to females about this period of life is strait clothes. They are fond of a fine shape, and foolishly imagine that this can be acquired by lacing themselves tight. Hence, by squeezing the stomach and bowels, they hurt the digestion, and occasion many incurable maladies. This error is not indeed so common as it has been; but, as fashions change, it may come about again: we therefore think it not improper to mention it. I know many females who, to this day, feel the direful 525effects of that wretched custom which prevailed some years ago, of squeezing every girl into as small a size in the middle as possible. Human invention could not possibly have devised a practice more destructive to health.

After a female has arrived at that period of life when the menses usually begin to flow, and they do not appear, but, on the contrary, her health and spirits begin to decline, we would advise, instead of shutting the poor girl up in the house, and dosing her with steel, asafœtida, and other nauseous drugs, to place her in a situation where she can enjoy the benefit of free air and agreeable company. There let her eat wholesome food, take sufficient exercise, and amuse herself in the most agreeable manner; and we have little reason to fear, but Nature, thus assisted, will do her proper work. Indeed she seldom fails, unless where the fault is on our side.

This discharge in the beginning is seldom so instantaneous as to surprise females unawares. It is generally preceded by symptoms which foretel its approach; as a sense of heat, weight, and dull pain in the loins; distension and hardness of the breasts; head-ach; loss of appetite; lassitude; paleness of the countenance; and sometimes a slight degree of fever. When these symptoms appear about the age at which the menstrual flux usually begins, every thing should be carefully avoided which may obstruct that necessary and salutary evacuation; and all means used to promote it; as sitting frequently over the steams of warm water, drinking warm diluting liquors, &c.

After the menses have once begun to flow, the greatest care should be taken to avoid every thing that may tend to obstruct them. Females ought to be exceeding cautious of what they eat or drink at the time they are out of order. Every thing 526that is cold, or apt to sour on the stomach, ought to be avoided; as fruit, butter-milk, and such like. Fish, and all kinds of food that are hard of digestion, are also to be avoided. As it is impossible to mention every thing that may disagree with individuals at this time, we would recommend it to every female to be very attentive to what disagrees with herself, and carefully to avoid it.

Cold is extremely hurtful at this particular period. More of the sex date their disorders from colds, caught while they are out of order, than from all other causes. This ought surely to put them upon their guard, and to make them very circumspect in their conduct at such times. A degree of cold that will not at the least hurt them at another time, will at this period be sufficient entirely to ruin their health and constitution.

The greatest attention ought likewise to be paid to the mind, which should be kept as easy and cheerful as possible. Every part of the animal economy is influenced by the passions, but none more so than this. Anger, fear, grief, and other affections of the mind, often occasion obstructions of the menstrual flux, which prove absolutely incurable.

From whatever cause this flux is obstructed, except in the state of pregnancy, proper means should be used to restore it. For this purpose we would recommend sufficient exercise, in a dry, open, and rather cool air; wholesome diet, and, if the body be weak and languid, generous liquors; also cheerful company and all manner of amusements. If these fail, recourse must be had to medicine.

When obstructions proceed from a weak relaxed state of the solids, such medicines as tend to promote digestion, to brace the solids, and assist the body in preparing good blood, ought to be used. 527The principal of these are iron and the Peruvian bark, with other bitter and astringent medicines. Filings of iron may be infused in wine or ale, two or three ounces to an English quart, and after it has stood for two or three weeks it may be filtered, and about half a wine-glass of it taken twice a-day: or prepared steel may be taken in the dose of half a drachm, mixed with a little honey or treacle, three or four times a-day. The bark and other bitters may either be taken in substance or infusion, as is most agreeable to the patient.

When obstructions proceed from a viscid state of the blood; or for women of a gross or full habit, evacuations, and such medicines as attenuate the humours, are necessary. The patient in this case ought to be bled, to bathe her feet frequently in warm water, to take now and then a cooling purge, and to live upon a spare thin diet. Her drink should be whey, water, or small beer, and she ought to take sufficient exercise. A tea-spoonful of the tincture of black hellebore may also be taken twice a-day in a cup of warm water.

When obstructions proceed from affections of the mind, as grief, fear, anger, &c. every method should be taken to amuse and divert the patient. And that she may the more readily forget the cause of her affliction, she ought, if possible, to be removed from the place where it happened. A change of place, by presenting the mind with a variety of new objects, has often a very happy influence in relieving it from the deepest distress. A soothing, kind, and affable behaviour to females in this situation is also of the last importance.

An obstruction of the menses is often the effect of other maladies. When this is the case, instead of giving medicines to force that discharge, which might be dangerous, we ought by all means to endeavour to restore the patient’s health and strength. 528When that is effected, the other will return of course.

But the menstrual flux may be too great as well as too small. When this happens, the patient becomes weak, the colour pale, the appetite and digestion are bad, and œdematous swellings of the feet, dropsies, and consumptions often ensue. This frequently happens to women about the age of forty-five or fifty, and is very difficult to cure. It may proceed from a sedentary life; a full diet, consisting chiefly of salted, high-seasoned, or acrid food; the use of spirituous liquors; excessive fatigue; relaxation; a dissolved state of the blood; violent passions of the mind, &c.

The treatment of this disease must be varied according to its cause. When it is occasioned by any error in the patient’s regimen, an opposite course to that which induced the disorder must be pursued, and such medicines taken as have a tendency to restrain the flux, and counteract the morbid affections of the system from whence it proceeds.

To restrain the flux, the patient should be kept quiet and easy both in body and mind. If it be very violent, she ought to lie in bed with her head low; to live upon a cool and slender diet, as veal or chicken broths with bread; and to drink decoctions of nettle-roots, or the greater comfrey. If these be not sufficient to stop the flux, stronger astringents may be used, as Japan earth, allum, elixir of vitriol, the Peruvian bark, &c.^[179]

529The uterine flux may offend in quality as well as in quantity. What is usually called the fluor albus, or whites, is a very common disease, and proves extremely hurtful to delicate women. This discharge, however, is not always white, but sometimes pale, yellow, green, or of a blackish colour; sometimes it is sharp and corrosive, sometimes foul and fœtid, &c. It is attended with a pale complexion, pain in the back, loss of appetite, swelling of the feet, and other signs of debility. It generally proceeds from a relaxed state of the body, arising from indolence, the excessive use of tea, coffee, or other weak and watery diet.

To remove this disease, the patient must take as much exercise as she can bear without fatigue. Her food should be solid and nourishing, but of easy digestion; and her drink rather generous, as red port or claret, mixed with Pyrmont, Bristol, or lime-water. Tea and coffee are to be avoided. I have often known strong broths have an exceeding good effect, and sometimes a milk diet alone will perform a cure. The patient ought not to lie too long a-bed. When medicine is necessary, we know none preferable to the Peruvian bark, which in this case ought always to be taken in substance. In warm weather, the cold bath will be of considerable service.

That period of life at which the menses cease to flow, is likewise very critical to the sex. The stoppage of any customary evacuation, however small, is sufficient to disorder the whole frame, and often to destroy life itself. Hence it comes to pass, that so many women either fall into chronic disorders, or die about this time. Such of them, however, as survive it, without contracting any chronic disease, often become more healthy and hardy than they were before, and enjoy strength and vigour to a very great age.

530If the menses cease all of a sudden, in women of a full habit, they ought to abate somewhat of their usual quantity of food, especially of the more nourishing kind, as flesh, eggs, &c. They ought likewise to take sufficient exercise, and to keep the body open. This may be done by taking, once or twice a-week, a little rhubarb, or an infusion of hiera picra in wine or brandy.

It often happens that women of a gross habit, at this period of life, have ulcerous sores break out about their ancles, or in other parts of the body. Such ulcers ought to be considered as critical, and should either be suffered to continue open, or have artificial drains substituted in their stead. Women who will have such sores dried up, are often soon after carried off by acute diseases, or fall into those of a chronic nature.

OF PREGNANCY.

Though pregnancy is not a disease, yet that state is often attended with a variety of complaints which merit attention, and which sometimes require the assistance of medicine. Some women indeed are more healthy during their pregnancy than at any other time; but this is by no means the general case: most of them breed in sorrow, and are frequently indisposed during the whole time of pregnancy. Few fatal diseases, however, happen during that period; and hardly any, except abortion, that can be called dangerous. We shall therefore pay particular attention to it, as it proves generally fatal to the child, and sometimes so to the mother.

Pregnant women are often afflicted with the heart-burn. The method of treating this complaint has been already pointed out. They are likewise, 531in the more early periods of pregnancy, often harassed with sickness and vomiting, especially in the morning. The method of relieving these complaints has also been shewn. Both the head-ach and tooth-ach are very troublesome symptoms of pregnancy. The former may generally be removed by keeping the body gently open, by the use of prunes, figs, roasted apples, and such like. When the pain is very violent, bleeding may be necessary. For the treatment of the latter, we must refer to that article. Several other complaints incident to pregnant women might be mentioned, as a cough and difficulty of breathing, suppression and incontinency of urine, &c.; but as all of these have been taken notice of before, it is needless to repeat them.

Every pregnant woman is more or less in danger of abortion. This should be guarded against with the greatest care, as it not only weakens the constitution, but renders the woman liable to the same misfortune afterwards^[180]. Abortion may happen at any period of pregnancy, but it is most common in the second or third month. Sometimes, however, it happens in the fourth or fifth. If it happens within the first month, it is usually called a false conception; if after the seventh month, the child may often be kept alive by proper care.

The common causes of abortion are, the death of the child; weakness or relaxation of the mother; great evacuations; violent exercise; raising great 532weights; reaching too high; jumping, or stepping from an eminence; vomiting; coughing; convulsion fits; blows on the belly; falls; fevers; disagreeable smells; excess of blood; indolence; high living; or the contrary; violent passions or affections of the mind, as fear, grief, &c.

The signs of approaching abortion are, pain in the loins, or about the bottom of the belly; a dull heavy pain in the inside of the thighs; a slight degree of coldness, or shivering; sickness, palpitation of the heart; the breasts become flat and soft; the belly falls; and there is a discharge of blood or watery humours from the womb.

To prevent abortion, we would advise women of a weak or relaxed habit to use solid food, avoiding great quantities of tea, and other weak and watery liquors; to rise early and go soon to bed; to shun damp houses; to take frequent exercise in the open air, but to avoid fatigue; and never to go abroad in damp foggy weather, if they can shun it.

Women of a full habit ought to use a spare diet, avoiding strong liquors, and every thing that may tend to heat the body, or increase the quantity of blood. Their diet should be of an opening nature, consisting principally of vegetable substances. Every woman with child ought to be kept cheerful and easy in her mind. Her appetites, even though depraved, ought to be indulged as far as prudence will permit.

When any signs of abortion appear, the woman ought to be laid in bed on a mattrass, with her head low. She should be kept quiet, and her mind soothed and comforted. She ought not to be kept too hot, nor to take any thing of a heating nature. Her food should consist of broths, rice and milk, jellies, gruels made of oatmeal, and the like, all of which ought to be taken cold.