Article VIII.—An Essay on Venereal Diseases, and the Uses and Abuses of Mercury in their Treatment. By Richard Carmichael, M.R.I.A. With Practical Notes, &c. by G. Emerson, M. D. Philadelphia, J. Harding, 1825; pp. 360.

One of the most important improvements in practice, which modern experience has established, is the reformed method of treating venereal diseases.

To the labours of several distinguished military physicians and surgeons of Great Britain, we are chiefly indebted for the facts and researches connected with this interesting subject. And although we may have much to learn in regard to the true nature of these complaints; yet the plan adopted by Mr. Carmichael, of determining their distinct pathological characteristics, and applying the remedies accordingly, is the only one likely to subvert the empirical routine of prescribing mercury on all occasions, a practice which derives such strong support both from the indolence and prejudices of the profession.

In this country, many eminent practitioners have contributed to restrain the abuse of mercury; and it is believed, that Professor Chapman has for many years, in his lectures, disseminated the most enlightened doctrines on this point. Dr. Harris and other surgeons of the navy have made a fair trial of the non-mercurial treatment, and with the most satisfactory results.

The great object, so desirable of attainment, is to form a correct discrimination between the diseases, which may be cured or benefited by the exhibition of mercury, and those which do not require this medicine, or become aggravated by its use; for it seldom fails to do injury, when its advantages are not very obvious.

Mr. Carmichael has taken the most conspicuous part in this investigation for the last fifteen years, and from the extensive theatre, in which his inquiries were conducted, has had the best opportunities of arriving at the truth. He, therefore, who undertakes the management of these affections, may be justly pronounced culpable, if he neglect to make himself acquainted with the experience of this eminent surgeon.

In this enlarged and improved edition of his work, several subjects have not been treated of so copiously by the author, as was requisite to render it acceptable as a book of reference; but the judicious notes of Dr. Emerson, whose attention has been profitably directed to the investigation of venereal diseases, have well supplied the deficiency.

A brief outline is here presented of the contents.

The author describes the various symptoms in plain and intelligible terms; rejecting such unmeaning appellations as syphiloidal, pseudo-syphilis, &c. as designating no particular phenomena, and therefore of no use in describing a disease.

He thinks there is a plurality of venereal poisons, and has divided the disease into four classes, from their different primary and secondary symptoms; making the eruptions on the skin the most certain criterion of distinguishing them from each other. These classes are:—the papular venereal disease; the pustular; The phagedenic; and the scaly venereal disease. The latter is the true syphilis.

First, the Papular. This is the most common disease, and the most easily cured. Its primary symptoms are, a simple ulcer without induration, without elevated edges, and without phagedena. Sometimes there is a patchy excoriation of the glans penis, attended with a purulent discharge. This disease and gonorrhœa are caused by the same poison. The constitutional symptoms are:—fever; pain in the head, shoulders, and larger joints, pain in the chest; dyspnœa; a papular eruption on the forehead, chest, and back, sometimes extending in a more scattered way over the extremities. It is often attended with iritis. It never gives rise to nodes. The sore throat is different from that of syphilis; the latter having deep excavated ulcers. If buboes accompany it, they are mostly of an indolent nature. The eruptions do not all appear at once; but follow each other. When on the decline, they are of a pale red or copper colour, not scaly, as in syphilis, but papular; disappearing and recurring repeatedly, and ending in desquamation.

Remedies.—Venesection; cathartics; antiphlogistic regimen; antimonials, combined with decoction of sarsaparilla. Alterative does of calomel and antimonials, when the eruption declines.

The local treatment consists in astringent washes and simple dressings.

Iritis is to be cured by venesection, cathartics, mercury, blisters, and belladonna.

This disease will yield to the powers of the constitution. Mercury is always injurious in the early stage.

Second, Pustular venereal disease.

Primary ulcer of a reddish-brown colour; borders closely on the phagedenic character. The edges raised and well defined; not excavated, but on a level with or above the surrounding skin. In the commencement, a small itchy pustula; distinguished from the ulcer attending the papular disease by its well defined and elevated edges, and by the absence of the smooth fungous surface of the former; from the phagedenic by its well defined margin and its corroded-like surface, and the absence of acute pain; and from chancre by the absence of the callous edges and base. These ulcers are of a chronic nature, showing little disposition to spread. The ulcers from buboes partake of the same character, the edges being hard and the ulcer disposed to burrow. These edges Mr. C. removes with the knife. The disease is rendered extremely obstinate, where full courses of mercury have been given. The more closely the eruption approaches the papular, the more mild and manageable will be the disease.

Constitutional symptoms.—The eruption is pustular, and often exhibits simultaneously new pustules; also scabbing ulcers, the crusts of which fall off, and leave discoloured patches of skin after healing. For these ulcers of the skin, the best remedies are, sulphur fumigations, nitro-muriatic acid baths, and ointment of tar and sulphur.

Remedies.—Rest; gentle astringents; mild ointments; antimonials and sarsaparilla:—for the constitutional symptoms; venesection; cathartics; antimonials; sarsaparilla.

Mercury is decidedly injurious, until the disease is on the wane, when alterative doses may accelerate the cure.

Third, Phagedenic venereal disease.

The primary ulcer has a corroded appearance. It exhibits neither granulations nor induration. It spreads sometimes rapidly, sometimes slowly; healing in one part, while ulcerating in another. It is mostly situated on the glans and prepuce, and often attended with hemorrhage. In this disease, buboes most frequently appear.

The sloughing ulcer occurs also in this disease. Mercury is extremely pernicious, always rendering the disease more inveterate and rapid in its progress.

Constitutional symptoms.—High fever precedes the eruption, but abates afterwards. Nocturnal headachs; tenderness of the scalp; slight dyspnœa; tenderness of the sternum on pressure; soreness of the chest; an eruption of tubercles, or pustules, or spots of a pustular tendency, which quickly degenerate into ulcers, with thick crusts, that heal from the centre, while they extend from the circumference, with phagedenic borders. The crusts are often of a conical figure. The ulceration of the throat is of the most formidable nature. It commences in the form of a small white aphthous sore; which usually attacks the velum or posterior part of the pharynx, mostly the latter. It extends rapidly, destroying the parts, and at last attacks the bones. It often attacks the larynx, after which, the patient seldom recovers. The affection of the bones of the nose is never joined with the papular eruption, nor with the scaly syphilitic lepra; but in every case with the pustular description, and when scales and ulcers were present. At the time of the eruption, pains in the knees, wrists, and ankles occur, attended with swelling and redness. He has never seen nodes in the disease, except in cases where mercury had been given. Full courses of mercury introduce the disease into the deep seated parts; for the bones are seldom or never affected in this disease, unless mercury has been given.

Remedies for the primary symptoms.—Absolute rest; venesection; nauseating doses of antimonials; warm poultices and fomentations; opium; hyosciamus and cicuta in sufficient doses to lessen pain and irritation. For the sloughing ulcer, stimulating applications are often useful; such as Venice turpentine or balsam copaibæ, mixed with olive oil.

For the secondary symptoms:—Venesection; antimonials; sarsaparilla; Dover's powder. Mercury increases the ravages of the disease, except when on the wane, when it may be given in alterative doses, with safety and advantage. For the pain in the head, a blister to the nape of the neck. If the eruption appear scaly, then mercury is likely to be useful. If the throat and skin are affected, muriate of mercury in solution, and decoction of sarsaparilla. If the ulcer in the throat be small, touch it with the oxymel æruginis, or solution of nitrate of silver, grs. v a x to an ounce of water; but if there exist extensive ulcerations, fumigations with red sulphuret of mercury ought to be employed.

Fourth, Scaly Venereal Disease, or Syphilis.—Primary ulcer of a circular form, excavated, without granulations, with matter adhering to the surface, and with a thickened edge and base. The hardening is very circumscribed, not diffusing itself gradually or imperceptibly into the surrounding parts, but terminating rather abruptly. Its progress is slow, sometimes assuming a tawny appearance.

Constitutional symptoms.—Sometimes the skin, at other times the throat, is first affected. There is headach, restlessness, and fever. The scaly eruption appears, but does not relieve the fever, as in the other diseases. This eruption commences with a small hard reddish protuberance; and as it advances, the sides are raised, and centre depressed or flat, and covered with thin white scales. It terminates in ulcerated blotches. This eruption appears on the forehead, breast, back of the neck, and groin; often in large copper coloured blotches, in parts near the hair. The ulcers of the throat mostly affect the tonsils, and come on without much previous pain or swelling; although there soon appears a considerable excavation of the tonsil, attended with evident loss of substance. The ulcer is foul, with thick white matter adherent to it, which cannot be washed away. The bones then become affected, those nearest the surface being most liable to attack; such as the tibia, sternum, clavicle, and cranium.

The remedies for syphilis are full courses of mercury, for both primary and secondary symptoms; except where a tendency to phthisis, or a delicate constitution forbids them. He thinks syphilis a rare disease now, compared with what it was formerly.