A TREATISE ON THE GONORRHOEA.

THE part principally affected by the Gonorrhoea is the penis, which con⯑ſiſts of three parts; two of which are called corpora cavernoſa, and lie on each ſide, and a third, which is ſituated underneath, named corpus ſpongioſum urethrae, con⯑ſiſting of the bulb and membranous part, continued on to the bladder, and termina⯑ting at the other extremity in the corona, or glans penis. The urethra has three glands, which were diſcovered by Cowper, and called mucous glands, from the tena⯑city of the liquor which they ſeparate. There are alſo two, (or rather one,) about the ſize of a nutmeg, they lie at the neck [8]of the bladder, between the veſiculae ſemi⯑nales and penis, under the oſſa pubis, al⯑moſt within the pelvis of the abdomen; they ſeparate a limpid glutinous humour, which is carried into the urethra by ſeveral ducts, which enter near thoſe of the pro⯑ſtatae The two firſt of Cowper's glands are about the bigneſs of a French bean, of a depreſſed oval figure, and a yellowiſh colour like the proſtatae, being on each ſide the bulb of the urethra, a little above it. Their excretory ducts ariſe from the internal ſurface next the inner membrane of the urethra, into which they open a little lower by two diſtinct orifices, juſt below the curvature of the oſſa pubis in perinaeo, where they diſcharge a tranſparent viſcous liquor. The third mucous gland is a ſmall conglobate yellowiſh gland, like the former, but ſomewhat leſs, ſituated above the angle of the flexure of the urethra, un⯑der the oſſa pubis, in the perinaeum, near the anus: it has two excretory ducts, which enter the urethra obliquely, a quarter of an inch below the two former, and diſcharges a liquor like them both in colour and con⯑ſiſtence.

The ſeat of the Gonorrhoea in women is the vagina, which is affected with a diſ⯑charge [9]charge like that of the urethra in men. It lies between the bladder and inteſtinum rectum, and has rugae, under which are ſmall glands, whoſe excretory ducts are called lacunae. Theſe glands ſeparate a mucilaginous ſlimy liquor to lubricate the vagina, and are the ſeat of the Gonorrhoea in this ſex, as the glands in the urethra are in the male. The meatus urinarius being a very ſhort paſſage, the heat and ſcalding is conſequently much leſs than in the men.

‘"A Gonorrhoea from the urethra in a man, begins with an uneaſineſs about the parts of generation, together with an ap⯑pearance of a little whitiſh matter, about the orifice of the urethra, a little ſwelling and ſometimes redneſs there, and a ſlight pungency upon the evacuation of urine. The whitiſh matter ſoon increaſes in quantity, the inflammation about the end of the urethra becomes more evident, and for the moſt part there is now a ten⯑ſion and hardneſs through the whole of it, a ſwelling of the lacunae, and a ſen⯑ſation of ſtricture in the penis, particu⯑larly on erection. The matter ſtill in⯑creaſes, flows out, and grows thinner, loſes all its adheſiveneſs, and is of a yellow, or greeniſh colour. There is [10]now always a redneſs about the end of the canal; often a pain from the diſ⯑tention of the urethra, during the eva⯑cuation of urine, and a much ſeverer to⯑wards the orifice, from its ſtimulus, with an increaſe of the redneſs juſt after it is evacuated. The inflammation prevents the extenſion of the urethra in erection, ſo that the penis is at that time curved downwards with great pain, which is in⯑creaſed if it be raiſed towards the belly, and the ſtimulus occaſions it often to be erected, eſpecially when warm in bed^*."’

I believe it would generally be eſteemed good practice on this occaſion to give nitre in conſiderable quantity, a purging elec⯑tuary, pill, or ſalts, and to take blood freely from the patient; alſo to direct large quantities of diluting liquors, and further to recommend a ſtrict regimen and abſtinence from particular meats, vegetables, and ſtrong liquors. The queſtion is, are ſuch medicines and reſtriction neceſſary? In my humble opinion they are not, and they appear, upon the whole, to do more harm than good, as I ſhall endeavour to demonſtrate from the experience of thoſe [11]who are well qualified to give an opinion in a matter of this kind, and alſo from my own obſervation and practice.

Dr. Cullen remarks, "that purgatives not only inflame the rectum, but alſo extend their irritation to the urethra." May not chordee and priapiſm then often be attri⯑buted to this cauſe?

Dr. Fordyce recommends "increaſing the ſecretion a little, by ſuch gentle pur⯑gatives as procure only two or three evacu⯑ations a day."—But who can enſure his patient two or three ſtools only in a day? The inteſtines being once put into motion, will not accommodate themſelves exactly to our wiſh or convenience. Happily for the patient, it is certain that even gentle purging may be diſpenſed with on theſe occaſions.

He adds, "that ſevere purging often augments the inflammatory ſymptoms, brings on ſtrangury and exulcerations, gives occaſion to inflammation of the teſticles, and other neighbouring parts, or it ſtops the running before the infection is waſhed off, and the Gonorrhoea either returns in a few days, or exulcerations take place."

The Doctor further obſerves, "that long continued purging is apt to weaken the [12]ſtomach and inteſtines, to hurt the di⯑geſtion, to produce obſtinate gleets, and leave hypochondriacal ſymptoms, particu⯑larly in irritable or melancholic habits."

Many more authorities might be adduced in proof of the bad effects of a courſe of purgatives in theſe caſes, which are generally of conſiderable duration, when treated in this manner. Neither are anti⯑phlogiſtic remedies to be depended upon, as they ſometimes produce the very contra⯑ry effect to what was expected from them: amongſt the firſt of theſe is nitre, in inflam⯑matory diſorders. Dr. Lewis, a late writer of no ſmall credit, reckons, that nitre often gives relief in ſtranguries, and heat of urine, proceeding either from a ſimple or a vene⯑real taint; and indeed the greateſt part of practitioners have always given it, and ſtill continue to give it in the venereal ardor urinae.

‘"This practice, however, ſays Dr. Hope in his lectures on the Materia medica, I am apt to believe has taken its riſe from the name of ardor having always been given to the pain in evacuating the urine, during the time of a venereal inflamma⯑tion of the urethra, and the name and virtues of a cooler, having always been [13]attributed to this ſalt. But it is certain that the urine paſſed during the time of a venereal inflammation is no warmer than at other times, and therefore to preſcribe a cooler to allay the heat of it, is abſurd: and I am perſuaded, that on a free and candid examination of this matter, it will be found, that nitre has not the ſmalleſt power of alleviating the pain which is then felt; for I have given it in all the different ſtages of this diſeaſe, in ſmall and in large doſes; but from the ſole uſe of it in a great number of trials, have never been able to obſerve that it afforded the leaſt relief. Nor, when we conſider the cauſe of that pain, and the effects of nitre, have we any reaſon to expect it; for the pain certainly proceeds from the acrid ſalts in the urine, ſtimu⯑lating the inflamed or excoriated urethra; and a ſolution of nitre applied to any ex⯑coriated part always gives conſiderable pain. Experiments aſſure us, that on taking nitre into the ſtomach, the urine becomes impregnated with it. The larger therefore the doſes are, the ſtronger will this impregnation be, and the greater ſtimulus added to the urine; ſo that we may ſenſibly conclude, that this ſalt will [14]rather augment than diminiſh the pain in evacuating it. The Doctor further re⯑marks, that there are many weak and delicate ſtomachs which cannot bear the cold it produces, and others in whom it always creates ſickneſs and nauſea."’

Beſides the diſagreeable circumſtance of taking great quantities of nauſeous me⯑dicines, we find there is the greateſt un⯑certainty as to their real effects on the diſeaſes they are intended to remove. A powder or medicine of any kind, applied to blood in a baſon, may viſibly affect that fluid, and render it thin or thick; yet being taken into the ſtomach, and poſſibly from thence into the circulation, it may have a very different effect on the circula⯑ting fluids, or perhaps none, having un⯑dergone a material alteration in its courſe.

A late celebrated Lecturer on the Mate⯑ria Medica, diſcourſing with his pupils on the powerful operations of mucilaginous medicines in the alleviation of the pain ariſing from the ſtone in the bladder, re⯑marked that ſuch medicines were extremely uſeful where the ſtone was of the mulberry kind, and apt to vellicate the coats of the bladder. He told them the ropy mucilage [15]would envelope the ſtone, and make a uni⯑formly ſmooth ſurface, entirely depriving it of its aſperities, and conſequently of its power of hurting the bladder.

It is difficult for one converſant with the mechaniſm of the human body, and the operation of medicine, to conceive, that a mucilage given by the mouth will arrive at the bladder in that ſtate. We are cer⯑tain that particular remedies will ſtimulate particular parts: balſam of capivi, for in⯑ſtance, being abſorbed, is known to af⯑fect the kidnies and bladder, by the ſtrong odour it imparts to the urine; but we do not find this, or any other medicine, ex⯑cept quickſilver, will paſs off in the ſame form in which it is adminiſtered by the mouth. This balſam is very much eſteem⯑ed for its great virtues, particularly in cer⯑tain ſtages of the Gonorrhoea, but it is ſo very diſagreeable, on account of its oily and bitter quality, as well as its ſmell, that ſome patients are ſoon diſguſted with it, and others will not be prevailed upon to take it at all; we cannot therefore think it ſtrange, that many gentlemen ſhould often prefer injections to all other means, which do not appear to produce effects in any degree equal to the trouble which at⯑tends [16]them. It muſt be acknowledged that patients often ſuffer more from the remedy than the diſorder; they are often more emaciated, weak, and pallid in their countenance, (circumſtances which fre⯑quently lead to diſagreeable diſcoveries,) from the operations of purgatives in the ſpace of one week, than they would have been in a month, if there had been no attempt made to check the progreſs of this diſorder.

There are many people who have not leiſure to purſue the ſeveral directions and preſcriptions given by practitioners; and if they could find time, they would have but little inclination to undergo ſo much fatigue and trouble. Such tedious pro⯑ceſſes are very ill contrived for the mul⯑titude, who muſt be, and are daily cured by means much more eaſy, expeditious, and quite as effectual; and if one claſs of men are cured in this manner, why ſhould not all enjoy the ſame benefit?

I have aſſerted, that a regimen, or par⯑ticular diet, is not neceſſary in the cure of the Gonorrhoea, when treated in the man⯑ner here recommended. Some have aſked, if the diſorder is not inflammatory, and if living low is not indiſpenſibly neceſſary [17]in every complaint of this kind? It may be ſaid in reply, that this is a local inflam⯑mation, which yields at once to a cooling detergent liquid applied to the part; whilſt internal medicines are commonly ſlow and uncertain in removing it.—When mercury does not paſs into the ſtomach, there is no occaſion to enjoin reſtrictions with reſpect to diet, ſince no diſagreement can then happen; patients may live in the ſame manner as at other times, only avoiding exceſs.

Dr. Hugh Smith, who is an advocate for vitriolic injections, aſſerts, "That a Go⯑norrhoea, if taken in the beginning, may generally be cured in a fortnight, without any injuty to the conſtitution, or any ill effects whatſoever^*."

I have met with the greateſt ſucceſs in the cure of this complaint from the ſame ſort of injections, and find they anſwer much better than mercurial ones, which depoſit a conſiderable ſediment, and being conveyed into the urethra, cauſe irritation and pain in that tender paſſage.

The injection ſhould be applied cold, rather than warm, (as cold braces and [18]warmth relaxes,) which I find often com⯑pletes the cure in much leſs than a fort⯑night, the time mentioned by the Doctor.

If the injection cauſes any more than a ſlight ſenſation of ſmart or pain in the paſ⯑ſage, it is evidently too much impregnated with vitriol, and the ſolution muſt be made weaker, as the irritation of the liquor would increaſe the ſymptoms inſtead of diminiſh⯑ing them.

The great objection to this ſort of prac⯑tice is raiſed on the ſuppoſition that In⯑jections are apt to produce ſtricture in the urinary paſſage, This idea, I apprehend, is not well founded; having enquired of many different people who have been troubled with ſtrictures, if they had uſed injections for the cure, and was generally anſwered in the negative.—I am much inclined to think with Doctor Fordyce, "That when a gonorrhoea continues long, it ſometimes produces a ſtricture in the part." Inflammation is naturally diſpo⯑ſed to produce contraction and ſtricture in the different ſacculi and paſſages of the body, as well as in the urethra: therefore we may conclude, that evils are often at⯑tributed to Injections, which in fact owe [19]their origin to other cauſes^*. The ſame gentleman juſtly obſerves, that omitting the injection once or twice will often make it fail of curing, when it would have other⯑wiſe produced that effect^†. He likewiſe remarks, that patients treated in this man⯑ner, are leſs liable to inflammation of the teſticles, or of the glands in the groin (on to chancres) or ſtrictures. Theſe obſerva⯑tions are certainly founded on fact. It is the general opinion, that ſmall doſes of mercury ought to accompany the Injection. See Fordyce, Saunders, Smith, and others.—Conformably to this idea, I give a grain of mercurial powder, and apply it to the cu⯑ticular ſurfaces of the lips, or the tongue, and at the ſame time make uſe of the vi⯑triolic, in preference to every other Injection. Though I have made repeated trials of ſe⯑veral, [20]I know of no other which would remove the diſorder in twice the time which this does; but there are ſome that would not ſucceed at all, and rather aggravate the ſymptoms.

It is now proved by a repetition of in⯑genious experiments, and generally admit⯑ted, that the diſcharge in a Gonorrhoea pro⯑ceeding from the wethra, is not pus, but mucus. Pus is the matter which proceeds from wounds and ulcers, but mucus comes from ſurfaces not ulcerated, though ſome⯑times inflamed. Dr. Hunter ſays, he has often diſſected the urethra of perſons who have died, having the Gonorrhoea at that time, and he adds, that he never diſco⯑vered any ulcer in the paſſage. Mucus is, in itſelf, an innocent, mild fluid, but ca⯑pable of acquiring virulence and acrimo⯑ny from contagious infection.

The Gonorrhoea is an increaſed and virulent diſcharge from the mucous glands^* of the urinary paſſage. Mucus, when untainted, is tranſparent like the white of an egg, appears as a drop ſometimes at the orifice of the urethra next the glands, is of a mucilaginous viſcidity, and its uſe is to ſheathe and defend the paſſage [21]from the irritating ſalts conveyed in the urine. It reſembles the fluid in the eye, which is ſecreted in ſmall quantity, but when the lachrymal gland is ſtimulated by grief, duſt, or other offending ſubſtance, the diſcharge becomes copious and ſome⯑times acrid.

Darwin obſerves, in his experiments on pus and mucus, "That whenever the ſecretion of any fluid is increaſed, there is at the ſame time an increaſed heat in the part." The ſame gentleman obſerves, that "the catarrhal humour from the noſtrils of ſome who ride in froſty weather, and the tears which run down the cheeks of thoſe who have an ob⯑ſtruction of the puncta lachrymalia, are eaſily diſtinguiſhed from others, by their abounding in ammoniacal or muriatic ſalts, whence they inflame the circumjacent ſkin: thus in the catarrh, the upper lip becomes red and ſwelled from the acrimony of the mucus, and patients complain of the ſalt⯑neſs of its taſte. The eyes and cheeks are red with the corroſive tears, and the ichor of ſome herpetic eruptions erodes far and wide the contiguous parts, and is pungent⯑ly ſalt to the taſte, as ſome patients have informed him."

When the mucous membrane of the noſe is ſtimulated by a violent cold, or other cauſe, we often ſee an extraordinary quantity of diſcharge from that organ; yet no one ſuſpects the exiſtence of any ulcers there, and I have often obſerved, that the diſcoloured mucus of that part bears ſo ſtrong a reſemblance to the viru⯑lent diſcharge in the gonorrhoea, that it would frequently perplex perſons conver⯑ſant in theſe matters to diſtinguiſh two handkerchiefs, the one from the other, when ſtained with the reſpective mucus. Either of theſe fluids having acquired acrimony will inflame, and ſometimes ſlightly exco⯑riate irritable nervous membranes. Theſe excoriations generally heal of themſelves, and when they do not, no one heſitates to apply repellent and healing medicines to the part, without even the ſmalleſt ſuſpicion of any bad conſequence. With ulcers the caſe is very different, there being the greateſt reaſon to apprehend danger from the abſorption of matter into the circulation. Writers of good credit aſſert, that a drop of acrid pus, abſorbed into the blood, affects all the fluids, ſtimu⯑lates the veſſels, and is capable of produ⯑cing violent diſorders, ſuch as putrid fe⯑vers, [23]&c. Impreſſed with ſuch a belief, no thinking man, in this or any age, would adopt a practice at once ſo irrational and dangerous: but as the diſcharge is merely mucus, and has no concern with the ſyſtem or animal oeconomy, it may be ſafely waſhed away, like any other ſordes, or filth from the ſurfaces of the body, by injec⯑tions, which are not only far more expedi⯑tious in producing their effects, but alſo appear, on a due compariſon of the merits of each, to poſſeſs another advantage, that of being a more cleanly, ſafe, and agreeable method of cure, than any other whatſoever. I have only to add in this place, that I am confirmed more and more in the uſe of in⯑jections, which entirely anſwer the above deſcription and commendation.