OF THE VIRULENT GONORRHŒA.
The Virulent Gonorrhœa is an involuntary discharge of infectious mucus from the parts of generation in either sex. It generally makes its appearance within eight or ten days after the infection has been received; sometimes it appears in two or three days, and at other times not before the end of four or five weeks. Previous to the discharge, the patient feels an itching, with a small degree of pain in the genitals. Afterwards a thin glary matter begins to distil from the urinary passage, which stains the linen, and occasions a small degree of titillation, particularly at the time of making water; this gradually increasing, arises at length to a degree of heat and pain, which are chiefly perceived about the extremity of the urinary passage, where a slight degree of redness and inflammation likewise begins to appear.
As the disorder advances, the pain, heat of the urine, and running, increase, while fresh symptoms daily ensue. In men the erections become painful and involuntary, and are more frequent and lasting than when natural. This symptom is most troublesome when the patient is warm in bed.
The pain which was at first only perceived towards the extremity, now begins to reach up all the urinary passage, and is more intense just after the patient has done making water. The running gradually recedes from the colour of semen, grows yellow, and at length puts on the appearance of mucus.
When the disorder has arrived at its height, all the symptoms are more intense; the heat of the urine is so great, that the patient dreads the making water; and though he feels a constant inclination this way, yet it is rendered with the greatest difficulty, and often only by drops; the involuntary erections now become extremely painful and frequent; there is also a pain, heat, and sense of fulness about the seat, and the running is plentiful and sharp, of a brown, greenish, and sometimes of a bloody colour.
By a proper treatment, the violence of the symptoms gradually abates; the heat and urine goes off, the involuntary and painful erections, and the heat and pain about the seat, become easier; and the running also gradually decreases, grows whiter and thicker, till at last it entirely disappears.
By attending to these symptoms, the gonorrhœa may be generally distinguished from any other disease. There are, however, some few disorders for which it may be mistaken, as an ulcer of the kidneys or bladder, the fluor albus, or whites in women, &c. But in the former of these, the matter comes away only with the urine, or when the sphincter of the bladder is open; whereas in a gonorrhœa the discharge is constant. The latter is more difficult to distinguish, and must be known chiefly from its effects; as pain, communicating the infection, &c.
Regimen.—When a person has reason to suspect that he has caught the venereal infection, he ought most strictly to observe a cooling regimen, to avoid everything of a heating nature, as wines, spiritous liquors, rich sauces, spices, salted, high seasoned, and smoke dried provisions, particularly salt itself in every shape; as also all aromatic and stimulating vegetables, as onions, garlic, shalot, nutmeg, mustard, cinnamon, mace, ginger, and such like. His food ought chiefly to consist of mild vegetables, milk, broths, light puddings, panado, gruels, &c. His drink may be barley-water, milk and water, decoctions of marshmallows and liquorice, linseed tea, or clear whey. Of these he ought to drink plentifully. Violent exercise of all kinds, especially riding on horseback, and venereal pleasures, are to be avoided. The patient must beware of cold, and when the inflammation is violent, he ought to keep his bed.
Medicine.—A virulent gonorrhœa can rarely be cured speedily and effectually at the same time. The patient ought, therefore, not to expect nor the physician to promise it. It will often continue for two or three weeks, and sometimes for five or six, even where the treatment has been very proper.
Sometimes, indeed, a slight infection may be carried off in a few days, by bathing the parts in warm milk and water, and injecting frequently up the urethra a little sweet oil, or linseed tea, about the warmth of new milk. Should these not succeed in carrying off the infection, they will at least have a tendency to lessen its virulence.
To effect a cure, however, astringent injections will generally be found necessary. There may be various ways prepared, but I think those made with the white vitriol are both more safe and efficacious. They can be made stronger or weaker as circumstances may require; but it is best to begin with the more gentle, and increase their power if necessary. I generally ordered a dram of white vitriol to be dissolved in eight or nine ounces of common or rose-water, and an ordinary syringe full of it to be thrown up three or four times a day. If this quantity does not perform a cure, it may be repeated, and the dose increased.
Whether injections be used or not, cooling purges are always proper in the gonorrhœa. They ought not, however, to be of the strong or drastic kind. Whatever raises a violent commotion in the body increases the danger, and tends to drive the disease deeper into the habit. Procuring two or three stools every second or third day for the first fortnight, and the same number every fourth or fifth day for the second, will generally be sufficient to remove the inflammatory symptoms, to diminish the running, and to change its colour and consistence. It gradually becomes more white and ropy as the virulence abates.[[1]]
[1]. If the patient can swallow a solution of salts and manna, he may take six drams; or, if his constitution requires it, an ounce of the former, with half an ounce of the latter. These may be dissolved in an English pint of boiling water, whey, or thin water-gruel, and taken early in the morning. If an infusion of senna and tamarinds be more agreeable, two drams of the former, and an ounce of the latter, may be infused all night in an English pint of boiling water. The infusion may be strained next morning, and half an ounce of Glauber’s salts dissolved in it. A tea-cupful of this infusion may be taken every half hour till it operates. Should the patient prefer an electuary, the following will be found to answer very well. Take of the lenitive electuary, four ounces, cream of tartar two ounces, jalap in powder two drams, rhubarb one dram, and as much of the syrup Of pale roses as will serve to make up the whole into a soft electuary. Two or three tea-spoonfuls of this may be taken over night, and about the same quantity next morning, every day that the patient chooses to take a purge. The doses of the above medicines may be increased or diminished, according as the patient finds it necessary. We have ordered the salts to be dissolved in a large quantity of water, because, it renders their operation more mild.
When the inflammatory symptoms run high, bleeding is always necessary at the beginning. This operation, as in other topical inflammations, must be repeated according to the strength and constitution of the patient, and the vehemence and urgency of the symptoms.
Medicines which promote the secretion of urine are likewise proper in this stage of the disorder. For this purpose an ounce of nitre and two ounces of gum-arabic, pounded together, may be divided into twenty-four doses, one of which may be taken frequently in a cup of the patient’s drink. If these should make him pass his urine so often as to become troublesome to him, he may either take them less frequently, or leave out the nitre altogether, and take equal parts of gum-arabic and cream of tartar. These may be pounded together, and a tea-spoonful taken in a cup of the patient’s drink four or five times a day. I have generally found this answer extremely well, both as a diuretic, and for keeping the body gently open.
When the pain and inflammation are seated high, towards the neck of the bladder, it will be proper frequently to throw up an emollient clyster, which, besides the benefit of procuring stools will serve as a fomentation to the inflamed parts.
Soft poultices, when they can conveniently be applied to the parts, are of great service. They may be made of the flour of linseed, or of wheat-bread and milk softened with fresh butter or sweet oil. When poultices cannot be conveniently used, cloths wrung out of warm water, or bladders filled with warm milk and water, may be applied. I have often known the most excruciating pains, during the inflammatory state of the gonorrhœa, relieved by one of these applications.
Few things tend more to keep off inflammation in the spermatic vessels, than a proper suspensory for the scrotum. It ought to be so contrived as to support the testicles, and should be worn from the first appearance of the disease, till it has ceased some weeks.
The above treatment will sometimes remove the gonorrhœa so quickly, that the person will be in doubt whether he really laboured under that disease. This, however, is too favourable a turn to be often expected. It more frequently happens, that we are able to procure an abatement or remission of the inflammatory symptoms, so far as to make it safe to have recourse to the great antidote mercury.
Many people, on the first appearance of a gonorrhœa, fly to the use of mercury. This is a bad plan. Mercury is often not at all necessary in a gonorrhœa; and when taken too early, it does mischief. It may be necessary to complete the cure, but can never be proper at the commencement of it.
When bleeding, purging, fomentations, and the other things recommended above, have eased the pain, softened the pulse, relieved the heat of urine, and rendered the involuntary ejections less frequent, the patient may begin to use mercury in any form that is least disagreeable to him.
If he takes the common mercurial pill, two at night and one in the morning will be a sufficient dose at first. Should they affect the mouth too much, the dose must be lessened; if not at all, it may be increased to five or six pills in the day. If calomel be thought preferable, two or three grains of it, formed into a bolus, with a little of the conserve of hips, may be taken at bed-time, and the dose gradually increased to eight or ten grains. One of the most common preparations of mercury now in use is the corrosive sublimate. This may be taken in the manner afterwards recommended under the confirmed lues or pox. I have always found it one of the most safe and efficacious medicines when properly used.
The foregoing medicines may either be taken every day, or every other day, as the patient is able to bear them. They ought never to be taken in such quantity as to raise a salivation, unless in a very slight degree. This disease may be more safely, and as certainly, cured without a salivation as with it. When the mercury runs off by the mouth, it is not so successful in carrying off the disease, as when it continues longer in the body, and is discharged gradually.
Should the patient be purged or griped in the night by the mercury, he may take half a dram of the opiate confection dissolved in an ounce of cinnamon-water, to prevent bloody stools, which are apt to happen should the patient catch cold, or if the mercury has not been duly prepared. When the bowels are weak, and the mercury is apt to gripe or purge, these disagreeable consequences may be prevented by taking, with the foregoing pills or bolus, half a dram or two scruples of diascordium, or of the Japonic confection.
To prevent the disagreeable circumstance of the mercury’s affecting the mouth too much, or bringing on a salivation, it may be combined with purgatives. With this view the laxative mercurial pill has been contrived, the usual dose of which is half a dram, or three pills night and morning, to be repeated every other day; but the safer way is for the patient to begin with two, or even with one pill, gradually increasing the dose.
To such persons as can neither swallow a bolus nor a pill, mercury may be given in a liquid form, as it can be suspended even in a watery vehicle, by means of gum-arabic, which not only serves this purpose, but likewise prevents the mercury from affecting the mouth, and renders it in many respects a better medicine.[[2]]
[2]. Take quicksilver one dram, gum-arabic reduced to a mucilage two drams; let the quicksilver be rubbed with the mucilage, in a marble mortar, until the globules of mercury entirely disappear; afterwards and gradually, still continuing the trituration, add half an ounce of balsamic syrup, and eight ounces of simply cinnamon-water. Two table-spoonfuls of this solution may be taken night and morning. Some reckon this the best form in which quicksilver can be exhibited for the cure of gonorrhœa.
It happens very fortunately for those who cannot be brought to take mercury inwardly, and likewise for persons whose bowels are too tender to bear it, that an external application of it will answer equally well, and in some respects better. It must be acknowledged, that mercury, taken inwardly for any length of time, greatly weakens and disorders the bowels; for which reason, when a plentiful use of it becomes necessary, we would prefer rubbing in to the mercurial pills. The common mercurial, or blue ointment, will answer very well. Of that which is made by rubbing together equal quantities of hogslard and quicksilver, about a dram may be used at a time. The best time for rubbing it in is at night, and the most proper place the inner side of the thighs. The patient should sit beside the fire when he rubs, and should wear flannel drawers next his skin at the time he is using the ointment. If ointment of a weaker or stronger kind be used, the quantity must be increased or diminished in proportion.
If, during the use of the ointment, the inflammation of the genital parts, together with the heat and feverishness, should return, or if the mouth should grow sore, the gums tender, and the breath becomes offensive, a dose or two of Glauber’s salts, or some other cooling purge, may be taken, and the rubbing intermitted for a few days. As soon, however, as the signs of spitting are gone off, if the virulency be not quite corrected, the ointment must be repeated, but in smaller quantities, and at longer intervals than before. Whatever way mercury is administered, its use must be persisted in as long as any virulency is suspected to remain.
During this, which may be called the second stage of the disorder, though so strict a regimen is not necessary as in the first or inflammatory state, yet intemperance of every kind ought to be avoided. The food must be light, plain, and of easy digestion; and the greatest indulgence that may be allowed, with respect to drink, is a little wine diluted with a sufficient quantity of water. Spiritous liquors are to be avoided in every shape. I have often known the inflammatory symptoms renewed and heightened, the running increased, and the cure rendered extremely difficult and tedious, by one fit of excessive drinking.
When the above treatment has removed the heat of urine, and soreness of the genital parts; when the quantity of running is lessened, without any pain or swelling in the groin or testicle supervening; when the patient is free from involuntary erections; and lastly, when the running becomes pale, whitish, void of ill smell, and tenacious or ropy; when all or most of these symptoms appear, the gonorrhœa is arrived at its last stage, and we may gradually proceed to treat it as a gleet with astringent and agglutinating medicines.