o Venery.

Anaphrodisia, Sauv. gen. 164. Sag. 270. Atecnia, Lin. 119. Agenetia, Vog. 283.

For this, see the article Impotence in the alphabetical order.

**Order III. DYSCINESIAE.**

**Genus CX. APHONIA.**

Loss of Voice.

Aphonia, Sauv. gen. 166. Lin. 115. Vog. 253. Sag. 272.

The loss of voice may proceed from various causes. If one of the recurrent nerves, which are formed by the par vagum and the nervus accessorius, and reach the larynx, be cut, the person is capable of only as it were a half-pronunciation; but if both be cut, the speech and voice are both lost. The loss of speech happening in hysteric patients is also called aphonia; but more properly that loss of speech is thus named which depends on some fault of the tongue.

Since the motion of any part is destroyed, or lessened at least, by the interception of the nervous fluid in its passage thither, and since the nerves destined for the motion of the tongue arise principally from the fifth pair, it appears that the seat of this disorder is in the fifth pair of nerves, and that the immediate cause is... Dyforexie is a diminution or total destruction of the nervous power in them. Hence a palsy of the tongue, which is either antecedent or subsequent to hemiplegic or apopleptic disorders, demand our utmost attention.

If an aphonia appears alone, it generally bespeaks an approaching hemiplegia or apoplexy; but if it succeed these disorders, and is complicated with a weak memory and a sluggishness of the mental powers, it threatens their return. That aphonia usually terminates the best which proceeds from a stagnation of serous humours compressing the branches of the fifth pair of nerves, which run to the tongue; but it is no less afflicting to the patient, and is very obstinate of cure.

Other causes of this disorder are, the striking in of eruptions on the skin, a congestion of blood in the fauces and tongue, obstruced periodical evacuations in plethoric habits, spasmodic affections, worms, a crumb of bread falling into the larynx, fear, too free an use of spirituous liquors; also whatever destroys the ligaments which go from the arytenoid to the thyroid cartilages, will destroy the voice.

The prognostics vary according to the cause. That species which is owing immediately to spasms, soon gives way on the removal of them. If a palsy of the tongue be the cause, it is very apt to return, though relieved, but often continues incurable.

In order to the cure, we must endeavour first to remove whatever obstructs the influx of the nervous fluid into the tongue, and secondly to strengthen the weak parts. These general intentions, in all cases, being regarded, the particular causes must be removed by remedies accommodated to each.

If worms be the cause, antispasmodics may give present relief; but the cure depends on the destruction or expulsion of the animals themselves. In case of a congestion of blood about the head, bleeding and nitrous medicines are to be used.—That species of aphonia which remains after the shock of an hemiplegia or apoplexy, requires blisters to be applied to the nape of the neck; if spasmodic constrictions about the fauces and tongue be the cause, external antispasmodics are of the greatest service, anodyne antispasmodics may be laid under the tongue, and the feet bathed in warm water; carminative clysters also are useful.—When a palsy of the tongue produces this complaint, evacuations, according to the patient's habit, must be made, and warm nervous medicines must be externally applied, and internally administered; blisters also should be placed between the shoulders.—In case of repelled cuticular eruptions, sudorifics should be given, and the patient's drink should be warm. The spiritus ammoniae succinatus, or vinum antimonii, may be employed either in combination with other articles, or by themselves, and given at proper distances of time, in the patient's drink, or on a bit of sugar.—Sometimes the serum flows so rapidly to the fauces and adjacent parts, in a salivation, as to deprive the patient of all power to speak; in this case diaphoretics and laxatives, with a forbearance of all mercurials, are the speediest remedies.

GENUS CXI. MUTITAS.

DUMBNESS.

Mutitas, Sauv. gen. 165. Vog. 257. Sag. 271.

Dumb people are generally born deaf; in which case the distemper is incurable by medicine: though even such people may be taught not only to read and write, but also to speak and to understand what others say to them. For some observations on the method in which this has been accomplished, we may refer the reader to the article DUMBNESS, in the alphabetical order. But in these cases, admitting of cure in the manner above alluded to, the dumbness proceeds principally, if not solely, from the deafness. For when it proceeds from a defect of any of the organs necessary for speech, the tongue for instance, it is always incurable; but if it arise from a palsy, the medicines applicable in that case will sometimes restore the speech.

GENUS CXII. PARAPHONIA.

Change in the Sound of the Voice.

Paraphonia, Sauv. gen. 168. Cacophonía, Sag. 274. Raucedo, Lin. 146. Raucitas, Vog. 252. Asaphia, &c. Vog. 250, 251, 254, 255, 256.

The voice may be changed from various causes. In males it becomes much more harsh about the time of puberty; but this can by no means be reckoned a disease. In others it proceeds from a catarrh, or what we call a cold; it arises also from affections of the nose and palate, as polypi, ulcers, &c., in which case the cure belongs properly to SURGERY. In some it arises from a laxity of the velum pendulum palati and glottis which makes a kind of snoring noise during inspiration. The cure of this last case is to be attempted by tonics and such other medicines as are of service in diseases attended with laxity.

GENUS CXIII. PSELLISMUS.

Defect in Pronunciation.

Psellismus, Sauv. gen. 167. Lin. 139. Sag. 273. Traulotis, &c. Vog. 258, 259, 260, 261.

Of this disease (if such it may be called), there are many different kinds. Some cannot pronounce the letter S; others labour under the same difficulty with R, L, M, K &c.; while some who can with sufficient ease pronounce all the letters, yet repeat their words, or the first syllables of them, in such a strange manner, that they can scarce be understood. Very frequently these defects arise entirely from habit, and may then be got the better of by those who have the resolution to attempt it; as we are told that Demosthenes the celebrated orator got the better of a habit of stammering by declaiming with pebbles in his mouth. Sometimes, however, pronunciation may be impeded by a wrong conformation of the tongue or organs of speech; and then it cannot by any pains whatever be totally removed.

GENUS CXIV. STRABISMUS.

SQUINTING.

Strabismus, Sauv. gen. 116. Lin. 304. Vog. 514. Sag. 222. Description. This disease shows itself by an uncommon contraction of the muscles of the eye; whereby the axis of the pupil is drawn towards the nose, temples, forehead, or cheeks, so that the person cannot behold an object directly.

Causes, Prognosis, &c. I. This disease may proceed from custom and habit; while in the eye itself, or in its muscles, nothing is preternatural or defective.

Thus children by imitating those that squint, and infants by having many agreeable objects presented to them at once, which invite them to turn one eye to one and the other eye to another, do frequently contract a habit of moving their eyes differently, which afterwards they cannot so easily correct. Infants likewise get a custom of squinting by being placed obliquely towards a candle, window, or any other agreeable object capable of attracting their sight: for though, to see the object, they may at first turn both eyes towards it; yet, because such an oblique situation is painful and laborious, especially to the most distant eye, they soon relax one of the eyes, and content themselves with examining it with the eye that is next it; whence arises a diversity of situation and a habit of moving the eyes differently.

In this case, which may admit of a cure if not too much confirmed, it is evident, that objects will be seen in the same place by both eyes, and therefore must appear single as to other men; but because, in the eye that squints, the image of the object to which the other eye is directed falls not on the most sensible and delicate part of the retina, which is naturally in the axis of the eye, it is easy to see that it must be but faintly perceived by this eye. Hence it is, that while they are attentive in viewing any object, if the hand be brought before the other eye, this object will be but obscurely seen, till the eye change its situation and have its axis directed to it; which change of situation is indeed very easy for them, because it depends on the muscles of the eyes, whose functions are entire; but, by reason of the habit they have contracted of moving their eyes differently, the other eye is at the same time frequently turned aside, so that only one at a time is directed to this object.

II. The strabismus may proceed from a fault in the first conformation, by which the most delicate and sensible part of the retina is removed from its natural situation, which is directly opposite to the pupil, and is placed a little to a side of the axis of the eye; which obliges such people to turn away the eye from the object they would view, that its picture may fall on this most sensible part of the organ.

When this is the case, the disease is altogether incurable, and the phenomena that arise therefrom differ in nothing from the phenomena of the former case, excepting only that here,

1. The object to which the eye is not directed will be best seen; which is the reverse of what happens when this disease arises barely from habit and custom.

2. No object will appear altogether clear and distinct; for all objects to which the eye is directed, by having their image painted in the retina at the axis of the eye, where it is not very sensible, will be but obscurely seen; and objects that are placed so far to a side of the optic axis as is necessary for making their image fall on the most sensible and delicate part of the retina, must appear a little confused, because the several pencils of rays that come therefrom fall too obliquely on the crystalline to be accurately collected in so many distinct points of the retina; though it must be acknowledged, that this confusion will, for the most part, be so small as to escape unobserved.

III. This disease may proceed from an oblique position of the crystalline, where the rays that come directly to the eye from an object, and that ought to converge to the point of the retina, which is in the axis of the eye, are, by reason of the obliquity of the crystalline, made to converge to another point on that side of the visual axis where the crystalline is most elevated; and therefore the object is but obscurely seen, because its image falls not on the retina at the axis of the eye, where it is most sensible: But the rays that fall obliquely on the eye, will after refraction, converge to this most sensible part of the retina; and, by converging there, must impress the mind with a clear idea of the object from whence they came. It is for this reason that the eye never moves uniformly with the other, but turns away from the object it would view, being attentive to the object to which it is not directed. When this is the case, it is in vain to expect any good from medicine.

The symptoms which naturally arise from it are,

1. The object to which the eye is directed will be but faintly seen, because its image falls on the retina where it is not very sensible.

2. The object to which the eye is not directed, by having its image painted on the retina at the axis of the eye, will be clearly perceived.

But, 3. This same object must appear somewhat indistinct, because the pencils of rays that flow from it are not accurately collected in so many distinct points in the retina, by reason of their oblique incidence on the crystalline.

4. It must be seen, not in its proper place, but thence translated to some other place situated in the axis of vision.

And, 5. Being thus translated from its true place, where it is seen by the other eye that does not squint, it must necessarily appear double; and the distance between the places of its appearance will be still greater, if the crystalline of the other eye incline to the contrary side.

IV. This disease may arise from an oblique position of the cornea; which, in this case, is generally more arched and prominent than what it is naturally.

When the eye has this conformation, no object to which it is directed can be clearly seen, because its image falls not on the retina at the axis of the eye; and therefore the eye turns aside from the object it would view, that its image may fall on the most sensible part of the retina.

When the strabismus proceeds from this cause, the prognostic and the phenomena that attend it will be much the same as in the case immediately preceding; from which nevertheless it may be distinguished by the obliquity of the cornea, which is manifest to the senses and if the cornea be also more arched and prominent than what it is naturally, which is commonly the case, the eye will also be short-sighted.

V. This want of uniformity in the motions of our eyes, may arise from a defect, or any great weakness or Dyschiria: or imperfection, in the sight of both or either of the eyes; and this, according to Dr Porterfield, is the most common cause of this disease. The prognostic in this case is the same with that of the disease from which it proceeds.

VI. Another cause from which the strabismus may proceed, lies in the muscles that move the eye. When any of those muscles are too short or too long, too tense or too lax, or are seized with a spasm or paralysis, their equilibrium will be destroyed, and the eye will be turned towards or from that side where the muscles are faulty.

In this case, the disease frequently yields to medicine, and therefore admits of favourable prognostics; excepting only when, by a fault in the first conformation, any of the muscles are longer or shorter than their antagonists; in which case, if ever it should happen, no medicine can be of any use.

As to what concerns the optical phenomena, they are the same here as in case first: only when the disease commences not till, by custom and habit, the uniform motion of the eyes has been rendered necessary, all objects do for some time appear double; but in time they appear single.

Lability, This want of uniformity in the motions of our eyes may proceed from a supernatural adhesion or attachment to the eyelids: of this we have an instance in Langius. And that the same thing may also be occasioned by a tumor of any kind within the orbit, precluding the eye aside, and restraining it from following the motions of the other, is so evident, that instances need not be brought to prove it. Here also the case may admit of a favourable prognostic; and as for what concerns the optical phenomena, they must be the same as in the case immediately preceding.

The cure, in confirmed cases, is to be effected by mechanical contrivances, by which the person may be obliged to look straight upon objects, or not see them at all; or at least that he may see with uneasiness and confusedly when he squints. In the 68th volume of the Philosophical Transactions we have an account of a confirmed case of squinting of a very uncommon kind. The patient was a boy of five years old, and viewed every object which was presented to him with but one eye at a time. If the object was presented on his right side, he viewed it with his left eye; and if it was presented on his left side, he viewed it with his right eye. He turned the pupil of that eye which was on the same side with the object in such a direction that the image of the object might fall on that part of the bottom of the eye where the optic nerve enters it. When an object was held directly before him, he turned his head a little to one side, and observed it with but one eye, viz. that most distant from the object, turning away the other in the manner above described; and when he became tired of observing it with that eye, he turned his head the contrary way, and observed it with the other eye alone, with equal facility; but never turned the axis of both eyes on it at the same time. He saw letters which were written on bits of paper, so as to name them with equal ease, and at equal distances, with one eye as with the other. There was no perceptible difference in the diameters of the irises, nor in the transparency of them after having covered his eyes from Strabismus.

These observations were carefully made by writing single letters on threads of paper, and laying wagers with the child that he could not read them when they were presented at certain distances and in certain directions.

As from these circumstances it appeared that there was no defect in either eye, which is frequently the case with persons who squint, and hence that the disease was simply a depraved habit of moving his eyes, the disease seemed capable of a cure. A paper gnomon was made for this purpose, and fixed to a cap; and when this artificial nose was placed over his real nose, so as to project an inch between his eyes, the child, rather than turn his head so far to look at oblique objects, immediately began to view them with that eye which was next to them. But having the misfortune to lose his father soon after this method was begun to be followed, the child was neglected for six years, during which time the habit was confirmed in such a manner as seemed to leave little room to hope for a cure. The same physician, however, being again called, attempted a second time to remove the deformity by a similar contrivance. A gnomon of thin brass was made to stand over his nose, with a half circle of the same metal to go round his temples: these were covered with black silk, and by means of a buckle behind his head, and a cross piece over the crown of his head, this gnomon was worn without any inconvenience, and projected before his nose about two inches and a half. By the use of this machine he soon found it less inconvenient to view all oblique objects with the eye next to them than the eye opposite to them.

After this habit was weakened by a week's use of the gnomon, two bits of wood, about the size of a goose-quill, were blackened all but a quarter of an inch at their summits; these were frequently presented to him to look at, one being held on one side the extremity of his black gnomon, and the other on the other side of it. As he viewed these, they were gradually brought forwards beyond the gnomon, and then one was concealed behind the other: by these means, in another week, he could bend both his eyes on the same object for half a minute together; and by continuing the use of the same machine, he was in a fair way of being cured when the paper was written.

Dr Darwin, who writes the history of the above case, adds, that all the other squinting people he had occasion to attend, had one eye much less perfect than the other: these patients, says he, are certainly curable by covering the best eye many hours in a day; as by a more frequent use of the weak eye, it not only acquires a habit of turning to the objects which the patient wishes to see, but gains at the same time a more distinct vision; and the better eye at the same time seems to lose somewhat in both these respects, which also facilitates the cure.

GENUS CXV. CONTRACTURA.

Contractions of the Limbs.

Contractura, Sauv. gen. 119. Lin. 299. Sag. 225. Ostitipitas, Sauv. gen. 11. Caput Caput obstipum, Vog. 513. Digitium, Vog. 221.

The contraction of various muscles of the body is generally the consequence of some other disease, as the rheumatism, gout, fever, or palsy, especially that species of the latter which follows the colica Pittonum. It is exceedingly difficult of cure; though the warm medicinal waters are much recommended, and have sometimes done great service. Of late electricity has been found to perform surprising cures in this way.

ORDER IV. APOCENOSES.

Apocenoae, Vog. Clas. II. Ord. II. Fluxus, Sauv. Clas IX. Sag. Clas V. Morbi evacuatorii, Lin. Clas IX.

GENUS CXVI. PROFUSIO.

FLUX OF BLOOD.

Profusio, Lin. 239. Hæmorrhagia, Vog. 81. Boerh. 218.

The disease commonly known by the name of bloody flux, is the putrid or contagious dysentery, a disease which has already been treated of. But independent of the discharge of blood which then takes place, hemorrhagy may take place from the alimentary canal as well as from other parts of the system. In such instances, however, if we except the place from which the discharge occurs, the phenomena are very much the same as in menorrhagia, haemoptysis, and other hemorrhages already treated of; while the disease is to be combated on the same principles and by the same remedies.

GENUS CXVII. EPHIDROSIS.

Excessive Sweating.

Ephidrosis, Sauv. gen. 258. Sag. gen. 194. Sudor, Lin. 263. Hydropedesis, Vog. 121.

This is generally symptomatic; and occurs in almost all fevers, but especially in the latter stages of the hectic. Sometimes it is a primary disease, arising merely from weakness; and then easily admits of a cure by the use of the cinchona, the cold bath, and other tonics.

GENUS CXVIII. EPIPHORA.

FLUX OF THE LACHRYMAL HUMOUR.

Epiphora, Sauv. gen. 259. Lin. 172. Vog. 99. Sag. 195.

This by Sauvages is described as an involuntary effusion of tears without any remarkable itching, heat, or pain. It follows long continued ophthalmias; or it may be occasioned by immoderate study, or anything that weakens the eyes; hence it comes on about the age of 50 years, when the eyesight naturally becomes weak. It in general grows worse in the winter-time, and is very hard to cure. Some authors re-

commend purgatives, and blisters on the nape of the neck, in order to draw off the abundant humours; but as the disease evidently proceeds from weakness, it would rather seem proper to pursue a contrary method. Sauvages recommends to the patients to abstain from study, wine, and salted meats; and also to avoid smoke or wind, and at night to foment the eyes with an infusion of four cloves in two ounces of proof-spirit.—Hungary water, rose water with fulphate of zinc dissolved in it, &c. have also been recommended.

GENUS CXIX. PTYALISMUS.

SALIVATION.

Ptyalimus, Sauv. gen. 261. Lin. 176. Vog. 103. Sag. 197.

A salivation is often symptomatic, but rarely a primary disease. Dr Cullen is of opinion, that when the latter happens to be the case, it arises from laxity; and then is to be cured by astringents and tonics. In the Medical Transactions we have the following account of a salivation brought on by a foreign substance irritating one of the parotid glands.

In the month of April 1751, a young lady about the age of 16 years, of a delicate habit, but subject to no particular complaints, perceived the beginning of a disease which afterwards proved most obstinate and loathsome, viz. an incessant spitting. The quantity of this discharge was different at different times, varying from one pint to two pints and an half in 24 hours. As to its quality, it seemed to be no other than the ordinary secretion of the salivary glands. By force and constant an evacuation, her strength became extremely impaired, and the most efficacious medicines had proved useless. She had taken large quantities of cinchona, both alone and combined with preparations of iron; and afterwards the fetid gums, opium, amber, alum, and the Neville-Holt water, had in succession been given her. In the mean time an exact regimen had been prescribed: she had been ordered to ride constantly; and to confine herself to a mucilaginous diet, such as veal, calves feet, &c. Likewise a gentle opening medicine had now and then been interposed. The disease still continuing unaltered, she had afterwards tried the tinctura saturnina; and had, at the same time, been encouraged to chew cinchona, and to swallow the saliva. But all these attempts had been vain; and after she had taken some or other of the medicines above mentioned until the end of September 1753, namely, above two years, it appeared to her physician, Sir George Baker, unreasonable to expect relief in such a case from any internal medicines whatever.

He now conceived a suspicion, that some extraneous body having accidentally found its way into the meatus auditorius, might possibly be the cause of this extraordinary secretion, by keeping up a continued irritation in the parotid glands. With this view he examined her ears, and extracted from them a quantity of fetid wool. How, or when, it came thither, no account could be given.

To this substance he attributed the beginning of the salivation, notwithstanding that the disease did not immediately abate on the removal of the wool; as it appeared to be no improbable supposition that the discharge It seemed, therefore, expedient to introduce some other habit, in the place of the increased secretion of saliva; which habit might afterwards be gradually left off. With this intention, he prevailed on the patient to chew perpetually a little dry bread, and to swallow it with her spittle. In a few weeks, it became necessary for her to chew the bread only at certain hours in the day; and thus, after two months, she became entirely free from a most disagreeable and tedious disorder.

It is worthy of observation, that, at first, the swallowing of so much saliva frequently occasioned a nausea; and that then, for a few hours, she was obliged to spit it out as usual; and that, during the greatest part of the time, when she chewed the bread, she had a stool or two every day more than common.

GENUS CXX. ENURESIS.

An involuntary Flux of Urine.

Enuresis, Sauv. gen. 264. Lin. 195. Vog. 113. Sag. 200.

This is a distemper which frequently affects children, otherwise healthy, when asleep; and is extremely disagreeable. Often it is merely the effect of laziness, and may be driven off by proper correction; but sometimes it proceeds from an atony or weakness of the sphincter of the bladder. Many ridiculous cures have been prescribed for it, and among the rest field-mice dried and powdered. Tonics are frequently of use; but sometimes the distemper proves obstinate, in spite of every thing we can use. In the London Medical Observations we find blisters much recommended in this disease, when applied to the region of the os sacrum. A girl of 13 years of age had been subject to an enuresis for four years. She could retain her water but a very little while in the day-time, but it flowed continually in the night. She had taken Peruvian bark and elixir of vitriol in considerable quantities; also valerian and the volatile julep, without effect. She was severely threatened, as the physician suspected it might arise from a bad habit; but this producing no effect, a blister was applied to the os sacrum, which in 24 hours totally removed the disease. A man aged 32, having been seized with an incontinence of urine and palsy of the lower extremities in consequence of taking a quack medicine, was cured of the incontinence of urine in 24 hours by one blister, and of the palsy itself by another. A woman of 50 having been seized with an enuresis and paralytic affection of the right thigh and leg in consequence of a sprain, was cured of both by a single blister. Several other cases are mentioned, by which the power of blisters in removing this distemper seems to exceed that of every other medicine whatever.

GENUS CXXI. GONORRHOEA.

Gonorrhoea, Sauv. gen. 208. Lin. 200. Vog. 118. Sag. 204.

The gonorrhoea is a flux of viscid matter of various colours, from the urethra in men and the vagina in women. It commonly proceeds from coition with a person infected with the venereal disease, and is one of the most common forms under which that disease shows itself.

Description. The first symptoms of the disease in men are commonly a sensation at the end of the penis not unlike a flea-bite, together with a fulness of the lips of the urethra, and some degree of tension in the penis, the urinary canal feeling as if tightened, and the urine flowing in a small and unequal stream: a little whitish mucus is to be seen about the orifice of the urethra, and oozing from it when slightly pressed, especially if the pressure be made on the spot where the foreskin is most felt. The discharge soon increases in quantity, and varies in its colour according to the degree of inflammation. The patient feels a sensation of heat and pain in evacuating his urine, particularly at certain spots of the urethra, and above all towards its orifice; and the involuntary erections to which he is subjected from the stimulus, particularly when warm in bed, occasion a distortion or curvature of the penis, attended with exquisite pain. When the inflammation is violent, the glans appears tumid and transparent, the tension extends through the whole of the penis, the perineum is affected with swelling and redness, and even the loins, buttocks, and anus, sympathize and afford a very uneasy sensation. Sometimes the prepuce inflames about the end of the penis, and cannot be drawn back, occasioning what is called a phymosis; at other times, as in the paraphimosis, it remains in an inflamed state below the glans, so that it cannot be drawn forwards; and, if the irritation and inflammation be violent, may terminate in gangrene. Now and then, especially when there is a phymosis, we may perceive a hard chord extending along the back of the penis. This is an inflamed lymphatic, and may be considered as a prelude to a bubo. When, however, a bubo does appear, almost universally some ulceration is previously to be discovered about the prepuce, or glans penis; which gives ground to presume that some other contagious matter besides that of gonorrhoea may have been applied to the urethra. For it is certain that matter capable of communicating the contagion of gonorrhoea to a female, is often copiously applied to the whole glans penis of a male for several days together, without giving either ulceration or bubo.

In mild cases, the seat of the disease is in the urethra, not far from its orifice; but it frequently happens that the virus infatuates itself much higher up, so as to affect Cowper's glands, the prostate, and parts very near to the neck of the bladder.

In the generality of cases, the inflammation goes on increasing for several days, commonly for a week or a fortnight; after which the symptoms begin to abate; and the running, when left to itself, gradually lessens in quantity, and becomes whiter and thicker, till at length it totally stops. The colour of the mucus, however, is by no means a certain guide in these cases: for in many patients it is of a yellowish, and sometimes of a greenish hue to the very last; but in general it becomes more confluent towards the close of the disease.

In women, the external parts of generation being fewer and more simple, the disease is less complicated than Sometimes the vagina only is affected; and when this happens, the symptoms are very trifling; but in general it comes on with an itching and sensation of heat as in the other sex; and is attended with inflammation of the nymphae, inside of the labia, clitoris, caruncula myrtiformer, the orifice and sometimes the whole of the meatus urinarius. Very often the deep-seated glands of the vagina are affected, and it is sometimes difficult to distinguish the discharge of a gonorrhea from that of the fluor albus.

Canfers, &c. Many ingenious arguments have of late been advanced to prove, that the gonorrhea and the lues venerea are different affections, originating from two distinct species of virus; and this controversy still, perhaps, remains to be decided by future facts. Certain it is, that in 19 of 20 cases of gonorrhea, no symptom whatever of syphilis appears; and that the disease readily admits of cure without having recourse to those remedies which are universally requisite for combating the contagion of syphilis. It is by no means wonderful, that in some cases both contagious, supposing them different, should be communicated at the same time. Nay, cases are by no means rare, where the contagion of itch, though essentially different from both, has been communicated with either. But as undeniable proof that the contagion in both cases is precisely the same, it has been alleged by some, that the matter of a chancre introduced into the urethra will generate a gonorrhea, and that the discharge from a gonorrhea will produce chancre, bubo, and every other symptom of syphilis. On the other hand, however, it is contended, that when experiments of this nature are conducted with the greatest accuracy, the matter of syphilis uniformly produces syphilis, and that of gonorrhea, gonorrhea only. Without pretending to decide on which of these experiments the greatest dependence is to be put, we may only observe, that while an almost inconceivably small portion of syphilitic matter applied to the glans penis, from connection with an infected female, infallibly produces syphilis if it be not speedily removed, the matter of gonorrhea, in every instance of that disease, is applied to the whole surface of the glans penis for many days together without producing almost any bad effect whatever. From this, therefore, there is ground for inferring, either that it is not capable of being absorbed, or that if absorbed it is innocent.

But while there have been disputes with regard to the peculiar nature of the matter in gonorrhea, there have also been controversies with respect to the source from whence it is derived. While some suppose it to be principally purulent matter arising from ulcerations, others assert that no such ulceration is ever produced in the urethra by gonorrhea. They contend that the increased secretion in these cases is exactly similar to what happens in the catarrh. But the comparison will by no means hold good in every particular: in the latter the whole membrane of the nose is equally irritated; whereas in the gonorrhea, only particular parts of the urethra seem to be affected. The disease, in the generality of cases, seldom extends more than an inch and a half along that canal, and in many is confined (at least in the beginning) to a small spot about an inch from the extremity of the glans. The discharge is produced from that part of the urethra where gonorrhea, the pain is felt; and the patient, when he voids his urine, feels no smarting till it reaches the inflamed spot; but as the disorder increases, the inflammation affects a greater number of points, just in the same manner as chancres affect different parts of the glans. It might be supposed that discharge would at once clear up this matter, and put an end to the dilute; but this is far from being the case. Dr Simmons has seen several urethras opened in persons who had a gonorrhea at the time of their death: in three of them the surface of the urethra, as in the cases related by Morgagni, appeared for some way down of a slight red colour, and in all of them was covered with mucus; but without any appearance of ulceration, except in two directions at Paris, in which most of the gentlemen present were convinced that they saw evident marks of it: but Dr Simmons says that the appearances were to him not sufficiently satisfactory to enable him to decide with certainty on the subject. On the other hand, when we consider that the discharge in a gonorrhea is sometimes tinged with blood, and that when this happens a little blood-vein is no doubt ruptured, we can have no reason to doubt that an ulceration may, and sometimes does, happen in these cases; especially as we often observe an excoriation near the orifice of the urethra. It is certain, that wherever there is considerable inflammation, there will be danger of ulceration. Besides, from a neglected or badly-treated gonorrhea, we often see fistulas in perineum, and other ulcers of the urethra, penetrating through its substance, and affording a passage to the urine. And there can be no doubt that slight ulcerations of this canal often occur, and are afterwards perfectly obliterated, in a similar manner to what happens in the papillae of the tongue, the tonsils, &c. Such an obliteration will the more readily take place in a part like the urethra, defended with mucus, and not exposed to the air, which is known to have no little effect in hardening a cicatrix.

But whether ulcers take place or not, whether the virus of gonorrhea be precisely of the same kind with that which gives syphilis, or of a different kind, there is reason from the phenomena of the disease to conclude, that the matter first acts by mixing with the mucus at the extremity of the urethra; and that from thence it is propagated upwards, particularly where the excretories of mucus are most numerous; and that on the parts to which it is applied, it operates as a peculiar irritating cause. The consequences of this irritation will be inflammation and an increased secretion of mucus; and so far the complaint will be local. In ninety-nine cases of an hundred a local affection of this kind constitutes the whole of the disease; and of this inflammation, ulcerations within the urethra, strictures, and other local affections, may be the consequence. But whether a disease of the habit ever takes place, unless when the contagion of syphilis is communicated with that of gonorrhea, still remains to be determined by future observations and experiments.

Nothing can be more variable than the period at which the disease makes its appearance after infection. Perhaps, at a medium, we may place it between the 4th and 14th day: but in some cases it happens within From what has been said of the manner in which the contagious matter in gonorrhoea acts, and of the influence it exerts on those parts with which it comes in contact, it follows, that the prevention of gonorrhoea must depend on the removal of the contagious matter, as soon as that can be done; and where this is either altogether neglected or not properly accomplished, that the cure must depend on counteracting the inflammation which this contagious matter excites, and the consequences which result from it.

The first of these intentions may be most certainly and most easily accomplished by careful lotion of all the parts to which the contagious matter has any chance of being applied. These parts, at least on the first application of the matter, are readily accessible; for even in men there is no reason to believe that it at first penetrates to any extent in the urethra. This washing of the parts should be performed as soon as possible; because then the matter is both most accessible and least involved with mucus: but although washing cannot be accomplished at an early period, it should not be neglected afterwards; for from the disease uniformly commencing, even when it does not appear till a considerable time after the application of the contagious matter, with a peculiar sense of titillation at the external parts, particularly in men at the extremity of the urethra, there is reason to believe that the contagious matter attached to the mucus may remain latent there for a very considerable time. For the purpose of washing, with a view to the prevention of this disease, recourse may be had to almost any watery fluid, provided it be not so stimulant as to produce bad effects from injuring the parts. Pure water, properly applied, is perhaps one of the best lotions; but there can be no doubt that its power in removing the contagious matter may be somewhat increased by such additions as render it a more powerful solvent of mucus. With this intention, one of the most powerful additions is the vegetable alkali, either in its mild or caustic state. In the latter state it is the most active, but in the former it is most safe; and the carbonas potash of the Edinburgh pharmacopoeia, to the extent of half a dram, dissolved in six or eight ounces of water, is one of the best lotions that can be employed. The purpose of removing the contagion may often also be effectually answered from washing with water impregnated with soap; for there the alkali, though in a caustic state, is prevented from exerting any disagreeable effects, in consequence of its being combined with oily matters.

With the view of preventing gonorrhoea, some have advised, that the alkali either in its mild or caustic state, properly diluted with water, should be injected into the urethra: and there can be no doubt, that by this means the contagious matter, when it has entered the urethra, may be removed. A removal may also be effected by the injection of a weak solution of corrosive sublimate, which seems to act not by dissolving the mucus but by producing an augmented secretion. But at a very early period of the disease, injections are probably unnecessary; and if it has made any considerable progress, they are dangerous: for from the augmented sensibility of the part, even very gentle ones are apt to excite a high degree of inflammation.

There are practitioners who, supposing that the body possesses powers to expel the virus, and that the disease has a certain period to run through its several stages of progress, acme, and decline, are for leaving the cure to nature; or at least content themselves with afflicting her by an antiphlogistic regimen, gentle evacuations, and the like.

That in many cases the disorder admits of a natural cure, there can be no doubt; the increased secretion of mucus carrying off the virus faster than it is formed, till at length the infection is wholly removed: But it is equally certain, that in every case, by the application of suitable remedies to the inflamed part, we may shorten the duration of the complaint, and abridge the sufferings of the patient, with the same certainty and safety as we are enabled to remove the effects of an ophthalmia or any other local inflammation, by proper topical applications. General remedies, such as occasional blood-letting, a cooling diet, the liberal use of diluting liquors, and mild purges, are by all allowed to be useful, and even necessary. Astruc was of opinion that in these cases blood-letting ought to be repeated five or six times; and there are still many practitioners who depend much on repeated evacuations of this sort for a removal of the inflammation. But there is, perhaps, not one case in ten in which it is at all requisite; and this small number of cases will confine only of the strong and plethoric: in such, when the chordee is frequent and painful, and the pulse hard and full, the loss of from eight to twelve ounces of blood will be beneficial, but it will be seldom necessary to repeat the operation. The inflammation in these cases is kept up by the local stimulus of the virus and the urine; and all that we can expect from venefication is to moderate the pain and the frequency of erection. In persons of a delicate habit, and of an irritable fibre, the evacuation will do no good; but if repeated will certainly be liable to do harm, by increasing irritability, and of course rendering the patient more susceptible of stimulus.

The utility, and even the necessity, of a cooling regimen, are sufficiently obvious; wine and spirituous liquors, spiceries, a fish-diet, much animal-food, and salted and high-seasoned dishes of every sort, will constantly add to the complaint. The patient should eat meat only once a day, and that sparingly. He should abstain from hot suppers. Milk, mild vegetables, and fruit, should constitute the principal part of his diet while the inflammatory symptoms continue. Everything that tends to excite the venereal imagination should be studiously avoided; for whatever promotes erections of the penis will increase the inflammation, and of course add fuel to the disease. For the same reasons much walking or riding on horseback will be hurtful, from the irritation kept up in the perineum by such means. Violent exercise of any kind, or anything that is liable to increase the heat and the momentum of the blood, will of course be improper.

The drinking freely of mild, cooling, mucilaginous liquors, such as linseed-tea, orgeat, whey, milk and water, almond emulsion, and the like, will be extremely useful, by diluting the urine, and preventing its salts from stimulating the urethra. When the heat and pain in making water are very considerable, mucilaginous substances Apocynous substances are found to have the best effect, particularly the gum tragacanth. It is a common practice to give equal quantities of this gum or gum-arabic and nitre, and to dissolve nitre in the patient's drink, with a view to lessen the inflammation. But in these cases nitre is always improper: it is known to be a powerful diuretic, its chief action being upon the urinary passages; so that the stimulus it occasions will only serve to increase the evil it is intended to alleviate. Superfluous use of potash, on account of its diuretic quality, will be equally improper. Our view here is not to promote a premature flow of urine; for the virus, being insoluble in water, cannot easily be washed away by such means; but our object ought to be, to render the urine that is secreted as mild and as little stimulating as possible.

Mild purges, which constitute another material part of the general remedies, are no doubt extremely useful when exhibited with prudence; but it is well known that the abuse of purgative medicines in this disease has been productive of numerous evils. Formerly it was a pretty general practice to give a large dose of calomel at bedtime, three or four times a week; and to work it off the next morning with a strong dose of the pilulae cocciae, or some other drastic purge. This method was persevered in for several weeks; in consequence of which the patient often found himself troubled with an obstinate gleet, and perhaps his constitution materially injured; the effect of such a method being (especially in irritable habits) to weaken the stomach and bowels, and lay the foundation of hypochondrial complaints. Violent purging likewise often occasions strangury, and other troublesome symptoms.

The cathartics employed in these cases should be gentle; such as Rochelle salt, magnesia, tartarised alkali, and the like. They should be given only in a dose sufficient to procure two or three stools, and be repeated only every two or three days. The daily use of the purgative electuaries that are still given by some practitioners, serves only to keep up a continual irritation on the bladder, and of course to prolong the inflammation.

The topical remedies that are used consist chiefly of different sorts of injections, the ingredients of which are extremely various; but their modes of operation may in general be referred to their mucilaginous and sedative, or to their detergent, stimulating, and astringent qualities. In the hands of skilful practitioners, great advantages may doubtless be derived from the use of these remedies; but, on the other hand, the improper and unseasonable administration of them may prove a source of irreparable mischief to the patient.

We know that mucilaginous and oily injections will tend to allay the local inflammation; and that a sedative injection, such as a solution of opium, will lessen the irritability of the parts, and of course produce a similar effect; the utility of such applications is therefore sufficiently obvious.

A detergent injection, or one that will act upon the mucus of the urethra, increase the discharge of it, wash it away, and with it the venereal virus that is blended with it, can only be used as a prophylactic before the symptoms of infection have made their appearance. But great circumvention is necessary in the use of this kind of injection. If it be too weak, it can be of no efficacy; and if it be too strong, it may prove dangerous to the patient. A suppression of urine has gonorrhoea been brought on by the improper use of an injection of this kind. When the symptoms of inflammation have once made their appearance, the stimulus of such an injection must be extremely hazardous. Excoration of the urethra has but too often been produced by remedies of this sort in the hands of adventurous and unskilful practitioners.

While the inflammation of the urethra continues, everything that stimulates it must be hurtful. If the injection excites a painful sensation in the urethra, as is but too often the case, it will be liable to produce swollen testicles, difficulty in making water, excoriation, and other effects of increased inflammation: if, by its astringency, the running be checked before the virus thus excited the discharge be properly subdued, the patient will be exposed to fresh dangers; and perhaps to a variety of local complaints, such as obstructions in the urethra, and abscesses in perineum, which are well known to be sometimes owing to applications of this sort improperly managed.

When the inflammation has subsided, gently stimulating and astringent injections may be used with safety, and with considerable advantage: for as the inflammation is at first excited by the stimulus of the venereal virus, so when the former begins to lessen, we may be assured that the activity of the latter has abated in proportion; and, in general, when the inflammatory symptoms are entirely removed, it will be found, that the mucus is no longer of an infectious nature, but is merely the effect of an increased secretion and of relaxation. Mild astringents will therefore serve to brace and strengthen the vessels secreting mucus, and in this way will lessen the discharge, and greatly promote the cure. It is certain, that in the greater number of cases, a gonorrhoea, which if treated by internal remedies alone, would continue for five or six weeks, or longer, may, when judiciously treated with injections, be cured in a fortnight, and very often in less time. The great aim, therefore, of the practitioner ought to be at first to make use of such injections only as will tend to lubricate the surface of the urethra, and to counteract and destroy the stimulus of the virus: as the inflammation abates, he may add some gently astringent preparation to a mucilaginous and sedative injection; taking care that its astringency be suited to the state of the disease, and to the irritability of the patient. Amongst a great variety of substances, mercury in different forms is one of those that is the most frequently employed in injections. All these mercurial injections have more or less of astringency; and, according to Dr Simmons, it is solely to this property that we are to ascribe their effects; for the idea of their correcting the venereal virus was originally introduced, and has, he thinks, been continued, upon mistaken principles.

Calomel, mixed with the mucus discharged in a gonorrhoea, has no more power in destroying the infectious properties of that mucus than ceruse or any other preparation would have. A diluted solution of sulphate injected into the urethra, will, like a solution of verdigris, or blue vitriol, or any other astringent, constringe the mouths of the lacunae; but this is all that it will do, for it will never lessen the infectious nature of the virus. The same thing may be observed of crude Apocynes—crude mercury extinguished by means of mucilage, or of mercurial ointment, blended with the yolk of an egg, and which, when thrown up into the urethra, will act nearly in the same manner as balsam of copaiva, or any other stimulating injection. The stimulus of mercury, however, has often been found of considerable efficacy; and in women, when the vagina only was affected, after washing the parts well, the cure has been accomplished by rubbing them repeatedly with mercurial ointment.

As the gonorrhoea is only a local affection, it may be inferred, that the internal use of mercury is unnecessary towards the cure. Very often indeed this complaint may be removed without having recourse to mercurials. Sometimes patients have been met with whose general health has been greatly impaired by a long continued use of mercury in such cases, while the original disease, the gonorrhoea, was rendered much worse by it. In some it has degenerated into a gleet, that was cured with extreme difficulty; in others it has brought on a variety of distressing symptoms. In cases of gonorrhoeas, therefore, whenever mercury is administered, it ought to be, not with a view to expedite the cure, but merely to obviate the dangers of syphilis. When the infection is apparently slight, and the inflammation and the symptoms trifling, we may proceed without the assistance of mercury, especially if the patient be of a weak, relaxed, and irritable habit, likely to be injured by mercurial medicines. On the other hand, when the discharge is violent, the inflammation considerable, or the seat of the disease high up in the urethra, it is perhaps the most prudent plan to give mercurials in small doses, and in such forms as seem the best adapted to the constitution of the patient.

The pilulae hydrargyri, as prepared according to the receipts inserted in the last edition either of the London or Edinburgh Pharmacopoeias, in both of which the mercury is rendered active merely by trituration, may perhaps be considered as one of the mildest and most efficacious forms under which mercury can be exhibited by the mouth. Its efficacy will depend on its not irritating the bowels, and thus passing off by stool; care must likewise be taken to prevent its affecting the mouth. Of the chemical preparations of mercury, the mildest and least irritating is calomel. It may be given from gr. iis. to gr. iii. at bed-time, occasionally interposing a mild purgative to prevent it from salivating; but in general the mercurial pill just mentioned is to be preferred.

When there is no chance nor bubo, no appearance in short of syphilitic infection, it would be improper to administer corrosive sublimate, the mercurius calcinatus, or any other of the more acid preparations of mercury.

After a gonorrhoea proceeding from venereal causes has been removed, another kind of running without pain, called the gonorrhoea mucosa, or gleet, sometimes remains. Sometimes it arises from a constriction and excoriation of the urethra, and frequently it is the effect of an enlargement and discoloured state of the prostate. In each of these cases, as the gleet is the effect of irritation, the cure will depend on the removal of the local disease that occasions it. But there is another species of gleet that seems to depend chiefly on relaxation. It is in general free from infection, and is most common in those who have had long and frequent gonorrhoeas. It is likewise often the effect of a debilitated habit, from severe purging, or a long continued use of mercurials. A discharge of this kind is more frequent in women than in men; or, at least, the fluor albus, after a gonorrhoea, will often be mistaken for a gleet.

When there is no reason to suspect remaining contagion, astringent injections will be of the greatest service. It will be necessary, at the same time, to attend to the health of the patient, by employing cinchona, chalybeate waters, cold bathing, and such other remedies as will tend to strengthen the system; and indeed by the use of these, particularly by the cinchona, such runnings are often successfully combated in those who from apprehension of dangerous consequences cannot be prevailed upon to employ injections. When there is no tendency to inflammation, the balsam of copaiva may be prescribed with advantage in large doses. Dr Simons says he once saw a complaint of this sort removed by applying a blister to the perineum, after it had resisted a variety of other remedies. In the Medical Observations also we have an account of a gleet and incontinence of urine removed at once by a blister to the os sacrum. In general, however, the other methods above mentioned will be sufficient to remove it, though sometimes it will continue for a long time in spite of all our endeavours to check it.—Other kinds of gonorrhoea, in which the semen itself is ejected, especially during sleep, may be cured by tonics and a mild cooling regimen.

ORDER V. EPISCHESSES.

GENUS CXXII. OBSTIPATIO.

COSTIVENESS.

Obstipatio, Lin. 166. Vog. 128. Sag. 221.

Costiveness is sometimes occasioned by debility in dyspeptic persons, sometimes it is the effect of rigidity, and sometimes it is symptomatic of the colic. It may proceed from an affection of the liver; drinking rough red wines, or other astringent liquors; too much exercise, especially on horseback; it may likewise proceed from a long use of cold unwholesome food, which does not sufficiently stimulate the intestines. Sometimes it is owing to the bile not descending to the intestines, as in jaundice; and at other times it proceeds from difficulties of the intestines themselves, as a palsy, spasms, tumors, &c.

Excessive costiveness is apt to occasion pains of the head, vomiting, colics, and other complaints of the bowels. It is peculiarly hurtful to hypochondriac and hysterical persons, as it generates wind and other distending symptoms.

Persons who are generally costive should live upon a moistening and laxative diet; as roasted or boiled apples, pears, stewed prunes, raisins, gruels with currants, butter, honey, sugar, and such like. Broths with spinach, leeks, and other soft pot-herbs, are likewise proper. Rye-bread, or that which is made of a mixture of wheat and rye together, ought to be eaten. No person troubled with costiveness should eat white bread alone, especially that which is made of fine flour. The best bread for keeping the belly soluble is what in some parts of England they call meflin. It is made of a mixture of wheat and rye, and is very agreeable to those who are accustomed to it.

Cotiliveness is increased by keeping the body too warm, and by every thing that promotes the perspiration; as wearing flannel, lying too long in bed, &c. Intense thought, and a sedentary life, are likewise hurtful. All the secretions and excretions are promoted by moderate exercise without doors, and by a gay, cheerful, sprightly temper of mind.

The drink should be of an opening quality. All ardent spirits, astringent wines, as port, claret, &c. ought to be avoided. Malt liquor that is fine and of a moderate strength is very proper. Butter-milk, whey, and other watery liquors, are likewise proper, and may be drank in turns, as the patient's inclination directs.

Those who are troubled with cotiliveness ought, if possible, to remedy it by diet, as the constant use of medicines for that purpose is attended with many inconveniences, and often with bad consequences. In time the custom becomes necessary, and generally ends in a total relaxation of the bowels, indigestion, loss of appetite, wasting of the strength, and death.

The learned Dr Arbuthnot advises those who are troubled with cotiliveness to use animal oils, as fresh-butter, cream, marrow, fat broths, &c. He likewise recommends the expressed oils of mild vegetables, as olives, almonds, pitiches, and the fruits themselves; all oily and mild fruits, as figs; decoctions of mealy vegetables; these lubricate the intestines; some sapacious substances which stimulate gently, as honey, hydromel, or boiled honey and water, unrefined sugar, &c. are useful.

The doctor observes, that such lenitive substances are proper for persons of dry atropharian constitutions, who are subject to attrition of the belly and the piles, and will operate when stronger medicinal substances are sometimes ineffectual; but that such lenitive diet hurts those whose bowels are weak and lax. He likewise observes, that all watery substances are lenitive; and that even common water, whey, four milk, and butter-milk, have that effect.—That new milk, especially after milk, stimulates still more when it flows on the stomach; and that whey, turned four, will purge strongly.—That most part of fruits are likewise laxative; and that some of them, as grapes, will throw such as take them immoderately, into a cholera morbus, or incurable diarrhoea.

When the body cannot be kept open without medicine, gentle doses of rhubarb may be taken twice or thrice a-week. This is not near so injurious to the stomach as aloes, jalap, or the other drastic purgatives so much in use. Infusions of senna and manna may likewise be taken, or half an ounce of tartarised alkali dissolved in water gruel. About the size of a nutmeg of lenitive electuary taken twice or thrice a-day, generally answers the purpose very well.

GENUS CXXIII. ISCHURIA.

SUPPRESSION of Urine.