IN the year 1779 I had an opportunity of obſerving, in his Majeſty's General Hoſpital at New York, the good Effects of OPIUM, in a variety of caſes, originally Venereal, in which Mercurial preparations appeared to be of no efficacy.

It happened that a great number of ſol⯑diers fell under my care at the ſame time, who laboured under evident ſymptoms of Morbid Irritability, which might be owing to different cauſes; but all theſe Patients were undergoing, or had undergone, a courſe of mercury.

Theſe ſymptoms, in all their variety of appearances and changes, at firſt ariſing from the venereal virus, and terminating [8]in what has ſince, upon reaſoning and re⯑flexion, appeared to me to have been brought on by Morbid Irritability, were all relieved, and finally the cure compleated, by alleviating pain, and procuring reſt.

And here I may remark, that ſoldiers in general are cured of the Venereal Diſeaſe with more difficulty than any other Patients, owing to their ignorance and inattention, or to their deſire of protracting the diſeaſe, and fruſtrating the uſual modes of relief.

The ſtate of the diſeaſe in which (as far as I am able to judge from the trials I have made) our expectations are likely to be anſwered from the uſe of Opium, is when the ulcers are ſpreading, or continue much the ſame, with a foul appearance, bad diſcharge, and much pain, the patient having little or no reſt, and all local applications ſeeming to be of no ſervice: to theſe ſymp⯑toms [9]may be added a quick pulſe, which is an invariable attendant, being, in gene⯑ral above an hundred, ſometimes an hun⯑dred and twenty, and ſometimes more, in a minute.

When I firſt adminiſtered Opium in caſes of this ſort, I had the ſatisfaction to find, that I gained two material points, viz. Eaſe and Reſt; with ſome in the firſt twenty-four hours, and in general within two days; afterwards, from theſe good conſequences, I was induced to continue the uſe of it, increaſing or diminiſhing the quantity as occaſion required, and entirely omitting at the ſame time the uſe of mer⯑curial applications, either externally or in⯑ternally.

Without entering into a diſquiſition on Opium, I take the liberty of concluding, that it will be ſufficient if I am enabled to [10]ſtate facts, and mention the uſeful effects of this medicine in a diſeaſe, which is one of the moſt violent that the human body can be afflicted with.

With regard to the action of Opium on the body in this diſeaſe, I have to obſerve, that in ſome patients its effects were ſudden, in others gradual; in general the circula⯑tion of the blood was very much decreaſed by it, and ſometimes the pulſe was ren⯑dered ſo ſlow as to beat only fifty and forty times in a minute; but this effect is not always neceſſary to the cure, as a good deal will depend upon the patient's diſpoſition to Irritability, which is the principal thing I attend to—for I have conſtantly obſerved, that as ſoon as that has been leſſened, ſome ſalutary change has been produced on the ſurface of the ulcer.

Its effects, in a few of the caſes, were almoſt inſtantaneous; amongſt theſe was that of a young man, twenty-two years of age, who had two Buboes (one in each Groin), which were opened and treated in the uſual way, but continued in an ulce⯑rated ſtate for five months, during which time he rubbed in three ounces and a half of ſtrong mercurial ointment, which ſeemed ſufficiently to affect the conſtitution: a pro⯑per diet was uſed, and every thing elſe di⯑rected which was thought neceſſary at the time. No change being perceived, he was ordered to waſh out, and take purging phyſick, which he did ſeveral times. Three weeks elapſed, and at this period he was not in the leaſt emaciated, but remained in full ſtrength and good habit of body. At this time the ulcers were foul, with thick edges, and the diſcharge from them ichorous, [12]with conſiderable pain; and the patient had little or no reſt. I then began with Opium, and gave him the firſt night one grain and a half only, directed a low diet, and dreſſed the ulcers in the moſt ſimple manner; the next day there was no altera⯑tion: I increaſed the doſe of the medicine, half a grain in that day; the following day he was much the ſame; but the day after⯑wards, which was the fourth, a favourable change was obſerved; and, from that time to the expiration of three weeks, gradual changes took place, and both ulcers per⯑fectly healed, without his having had oc⯑caſion to increaſe the doſe, or to make uſe of any other medicine. And here I will beg leave to remark, that with every pa⯑tient I have avoided as much as poſſible ſuch applications as ſeemed to make the parts in any way uneaſy. A ſoft well-made [13]bread and milk poultice will anſwer in the early part of the treatment, and afterwards dry lint and cerate; but, if a fungus exiſts, I prefer a ſolution of thebaic extract in an oatmeal poultice, applied cold in contact with the ſore, to any thing elſe.

The manner in which the alteration takes place is both curious and ſingular; the firſt favourable ſymptoms are eaſe and reſt; the next, if I may be allowed the expreſſion, is an unfolding or looſening of the texture of the ſurface of the ulcer after the irritability is leſſened, which ef⯑fect ſoon takes place, the parts are in a ſtate of relaxation, owing to the ſtricture on the ſurface being relieved, and finally the cure is aſſiſted by the ſkin corrugating, or contracting to the center of the ulcer, unaided by ſtimulating applications, and, [14]frequently, with very little aſſiſtance, by the uſual way of a new ſkin.

In ſeveral caſes I have obſerved the cure go on extremely well, without the ſurface of the ulcer appearing florid at any one time, as is uſual in healthy-looking ſores. I am very happy in this part, in having Mr. Wier's, Surgeon of his Majeſty's Mili⯑tary Hoſpitals, permiſſion to ſay, that he has obſerved all the above facts that I men⯑tion. And ſince that, having communi⯑cated my ideas to Mr. Forſter, who is like⯑wiſe Surgeon of his Majeſty's Military Hoſ⯑pitals, and whoſe abilities I reſpect, I have much ſatisfaction in being able to add his opinion in corroborating the above facts; Mr. Forſter having obſerved the ſame ap⯑pearances, and changes, that I have en⯑deavoured to deſcribe.

The third, fourth, or fifth day was the time I in general found the appearance of the ſores change for the better.

The doſe that I have in general begun with in this diſeaſe, has been about one grain and a half the firſt night, which I have increaſed night and morning, until I found it anſwered the intended pur⯑poſes. With a view of keeping the patient quiet, and leſs diſpoſed to move, I always divided the time, and therefore gave it night and morning; and what is very ex⯑traordinary, the patient in the day-time never appeared to me more drowſy than if he were not making uſe of the medicine; but with ſome an indolency took place, and continued, or diſcontinued, either as the conſtitution became uſed to the medi⯑cine, or to the variation of the doſe. I confeſs myſelf, I was always happy when [16]it appeared; as I never knew any harm accrue from it: and, beſides its own action internally, Opium diſpoſes a reſtleſs temper of mind, to obſerve a proper regimen, and to obey any directions that may be thought neceſſary at the time. I have always ob⯑ſerved, that it is beſt to keep the patient ignorant of the medicine whilſt he is uſing it.

A tremor, which ſometimes came on, never obliged me to decreaſe the doſe, or to pay any particular attention to this ſym⯑ptom, unleſs the bowels were diſpoſed to be coſtive; and then a purge readily relieved it in a great meaſure.

The preparation that I invariably gave my patients was Extractum Thebaicum; if any objection aroſe to its being uſed in a ſolid ſtate, I preferred diſſolving the doſe [17]in plain water to the tincture, or any other form.

With regard to the quantity that may be given, I will not determine; I think for the moſt part the diſeaſe yielded to about four or ſix grains a day; I have in two or three caſes given eight grains, and in one extraordinary caſe of a cancerous lip, of near three years ſtanding, I in⯑creaſed the quantity to twenty-four grains in a day, divided in three doſes; the patient was a man about fifty years of age, and I was ſix weeks in bringing him to this doſe, which I continued for a few days, and finding that it did not do any material ſervice in the progreſs of the cure, I diſ⯑continued it; yet now and then a favour⯑able change ſeemed to appear, for two ſinuſes that I had occaſion to lay open di⯑geſted [18]well, and cloſed; no ill effects were produced by the medicine, excepting ſome⯑times a giddineſs, which was always re⯑lieved by a gentle purge; previous to his making uſe of Opium, he had always a quick pulſe; but it afterwards decreaſed to between forty and fifty ſtrokes in a mi⯑nute, and continued ſo for ſome time. And I cannot help being very much of opinion, that had Opium been properly given in the earlier ſtate of the diſeaſe, a cure might have been obtained: and in this opinion I am confirmed by a caſe I have lately at⯑tended; which was an ulcer in the mouth of three months ſtanding, with all the characteriſtic marks and ſymptoms of an Incipient Cancer, which was compleatly cured by Opium and Cicuta joined. This patient (Major Sinclair) Dr. Garthſhore [19]attended with me; the firſt time we ſaw him we agreed in opinion with reſpect to the means to be purſued for his cure, and never had occaſion to deviate from the plan. Before he began the uſe of theſe medicines, he was almoſt in a ſtate of diſtraction from pain, and his pulſe beat an hundred and twenty ſtrokes in a minute. This quickneſs of pulſe was diminiſhed on the third day, and about the tenth the ulcers changed for the bet⯑ter; and in a month afterwards he was quite well^*.

Gentle Purges frequently become ne⯑ceſſary in the early part of uſing the medicine, though in a ſmall doſe, eſpe⯑cially where the body is diſpoſed to be [20]coſtive; and I have generally found that a little glauber ſalts anſwered the purpoſe, as this operated without my being obliged to delay the uſe of Opium; on the ſecond or third day with ſome a head-ach came on in conſequence of the bowels being conſtipated; but this always readily gave way to a gentle purge, and I have always found, that as the conſtitution became uſed to the medicine the pain of the head was no longer an attendant, and in gene⯑ral the body became regular; nay, with ſome a Diarrhoea has been produced, which has continued for two or three days, and that without ſeeming to do any harm.

An increaſed ſecretion of ſaliva is not uncommon, as well as of urine; it does not depend upon taking a large quantity, for it will happen ſometimes in the firſt [21]ſix days; but neither one, nor the other, ſeems at any time to be injurious, nor does it appear neceſſary to forward the cure, as patients who have experienced neither of thoſe effects have obtained it in as ſhort a ſpace of time.

One remark further I muſt add, with regard to diet, viz. that until I procured eaſe and reſt, I continued the patient on a low diet, which I in general began with; and as circumſtances changed afterwards, ſo I made ſuch alterations as the conſtitu⯑tion ſeemed to require; ſometimes adding meat, and ſometimes either a gill of rum in the day, or wine in proportion.

From the above obſervations it will ap⯑pear, that I am inclined to confine the good effects of Opium (which are indeed very conſiderable) to an advanced ſtage of [22]the diſeaſe, or what, in my humble opi⯑nion, may more properly be termed Mor⯑bid Irritability ſimply, in which ſtate, mer⯑cury has either loſt its efficacy, or ſeems to do miſchief; and this irritability may, I apprehend, probably ariſe from different cauſes, as it certainly may be a queſtion, whether there was any Virus of a Vene⯑real Nature, remaining in the caſes in which I gave Opium: however that may be, the good effects of the medicine were unqueſtionable; and it will appear that I do not truſt to Opium as a ſpecific in re⯑cent caſes, or where any part of the Vene⯑real Virus might ſeem to remain; for the laſt caſe I had under my care being of ſo complicated a nature, I joined Mercury with the Opium for the laſt three weeks, but not till I had fully and effectually [23]relieved the ſymptoms of Morbid Irrita⯑bility.

The caſe I allude to was, that of a bad ſore throat, which came under my care about ſix months ago: the patient was a gentleman about three or four and thirty years of age, and of a thin habit.—At the time I firſt ſaw him he was rather in an emaciated ſtate: he was purſuing a courſe of mercury, which he had began about two months before. I found upon examination ſeveral ulcers in the Fauces, and a large one on the left tonſil; a ſe⯑vere pain on the forepart of one leg, with the Perioſteum thickned—an eruption on his breaſt, his pulſe beating an hundred and thirty ſtrokes in a minute; a moſt reſtleſs diſpoſition—great anxiety—and he had not had any ſleep for ſome weeks: [24]I omitted entirely the whole of the plan he was then upon, and did not give him any thing till bed-time, when he took one grain and a half of Opium, with directions to repeat one grain the morning following. Upon ſeeing him the next day, before I aſked him a queſtion, he cried out, "I am a well man to what I was; I have had no pain ſince laſt night, and ſlept well." This formed the foundation of his cure. I increaſed the doſe, till he took three grains at night, and two in the morning.

On the ſecond day he made uſe of the ſteam of hot water, through the inhaler, which he repeated occaſionally afterwards with evident advantage.

On the third day the ulcers ſeemed to appear cleaner, and every day afterwards [25]he gradually grew better, till the twenty-fourth day, when all the parts were heal⯑ed.—On the fifth day I obſerved that his pulſe was in a natural ſtate, and it con⯑tinued ſo the whole time of his re⯑covery.

The eighth day after uſing the Opium a ſpitting came on, and continued eleven days. For a few days he ſpit about a pint each day. This did not weaken him in the leaſt—from being confined to his bed, he was able to walk about, and every day gained ſtrength. Juſt at this time I directed a quart of very ſtrong decoction of Sarſaparilla to be taken every day, which produced a gentle diaphoreſis; and I continued this plan for ſix weeks, and, for the ſake of ſecurity, for the laſt three weeks I joined to the Opium at bed-time [26]half a grain of Mercurius Calcinatus. In the courſe of the firſt fortnight the erup⯑tion diſappeared, and the thickened Perioſ⯑teum gave way to a bliſter.

On the 20th day, I began to decreaſe the quantity of Opium.

And from the 24th to the 42d day, when I left it off, conſidering him as per⯑fectly cured, I only gave one grain in the twenty-four hours—He had occaſion to make uſe of purging medicines at dif⯑ferent times, owing to a coſtive habit of body; but theſe never interfered with the Opium.

As conciſely as poſſible I will juſt men⯑tion, among other caſes, the following:

William Rockett, of the detachment of Guards that was in America during the late war, thirty-ſeven years of age, had [27]ulcers on each tonſil, and almoſt the whole of the fauces, with violent pains in his bones. Theſe complaints were of three months ſtanding; mercurials, and other medicines, had been adminiſtered during the whole of that time.

He was of a thin habit of body, with a pulſe from an hundred and twenty to an hundred and thirty ſtrokes in a minute. He began with one grain and a half of Opium the firſt night.

On the third day, no alteration having taken place, I increaſed the doſe one grain.

The next day, to appearance the ulcers ſeemed not quite ſo angry; and in every other reſpect he was better.

On the eighth day, he appeared weak, and his throat in general relaxed. I [28]omitted the Opium, and began with the Peruvian Bark, in as large doſes as the patient's ſtomach would bear, and or⯑dered him to make uſe of an aſtringent gargle.

On the tenth day, the Bark occaſioning nauſea, I was obliged to leave it off. The pain in his bones returning with vio⯑lence, I again gave him two grains in the morning.

The next day he was better.

On the twelfth day, as he was much the ſame, I increaſed the doſe, one grain in the morning, and continued this plan to the fifty-ſecond day, without varying the doſe; when every thing ſeemed to go on ſo extremely well, and the pains of the bones having left him, I omitted the two grains in the morning.

In a week afterwards all the ulcers were healed; and he was gaining ſtrength daily. I continued one grain at night for a fortnight longer, and diſcharged him from the hoſpital perfectly cured. It was near a fortnight before the pulſe returned to its natural ſtate; and afterwards it was frequently under ſixty.—This caſe hap⯑pened among the firſt in the year 1779; and Mr. Ruſh, Surgeon to the Second Troop of Horſe Grenadier Guards, and late Surgeon to the Brigade of Guards in North America, was witneſs to the whole of the treatment.

Thomas Wells, thirty-ſix years of age, of a ſtrong plethorick habit of body, with rather a full pulſe, had ſmall ulcers on the tonſils and fauces, and an ophthalmia, for which he had been ſalivated without the leaſt benefit. I directed for him a low diet, [30]and began with giving him one grain of Opium night and morning.

The next day he was eaſier.

The ſecond day much the ſame.

The third day a good deal better.

And on the ſixth day, being much the ſame, I increaſed the doſe one grain at night.

The next day he was going on well, and continued getting better till the four⯑teenth day, when his throat was quite well, and his eyes much relieved.

On the ſixteenth I omitted the Opium in the morning.

And on the eighteenth, as he was nearly well, I omitted one grain at night.

On the twenty-third, the inflammation was gone; and in every other reſpect he was perfectly well.

On the thirtieth day the Opium was en⯑tirely omitted; and he was diſcharged from the hoſpital.

April 7th, 1782, I was deſired to ſee John Blewers, a ſailor, twenty-eight years of age, of a plethorick habit of body, with ulcers on the glans penis, a phymoſis, the praeputium in a gangrenous ſtate, and ſuf⯑fering moſt excruciating pain; his pulſe beat an hundred and twenty-ſtrokes in a minute, and appeared to be increaſing in quickneſs. He had rubbed enough of the mercurial ointment to affect his mouth twice.

I began with two grains of Opium at night and one in the morning.

The next day, he ſaid he had enjoyed a good night's reſt, which he had been a ſtranger to for ſome time.

On the ninth he was much the ſame in appearance; and I directed two grains of Opium to be taken night and morn⯑ing.

On the tenth he had eaſe and reſt.

On the eleventh the pain was much relieved; and there was an appearance of part of the praeputium ſloughing.

On the twelfth he was not quite ſo well; and the doſe of Opium was now increaſed to three grains night and morning.

Thirteenth, he was better.

Fourteenth, the ſlough was thrown off; and he was better in every reſpect.

Fifteenth, he was in a good ſtate, and continued going on well till the eighteenth of May, when the ulcers being nearly healed, I decreaſed the doſe of Opium to four grains a day.

Twentieth and twenty-firſt, I decreaſed the doſe two grains more.

Twenty-fifth, he was quite well, but continued to take a ſingle grain a day for a week longer.

Beſides the above, I had the ſatisfaction of effectually relieving, with the ſame manner of treatment, ten other patients; of whom, ſix had either obſtinate or ſpreading ulcers in the groin; one an ulcerated glans penis; and three ulcerations of the tonſils and fauces.

HAVING remarked, that in caſes where fungus exiſts I prefer a ſolution of thebaic extract in an oatmeal-poultice, made and applied cold, I beg leave, as proofs of its peculiar efficacy, to add the two following [34]caſes; neither of which, as far as my en⯑quiries went, originated from the Venereal Diſeaſe.