A chancre is sometimes a primary affection, but it is much oftner symptomatic, and is the mark of a confirmed lues. Primary chancres discover themselves soon after impure coition, and are generally seated in parts covered with a thin cuticle, as the lips, the nipples of women, the glans penis of men, &c.[[172]].
When a chancre appears soon after impure coition, its treatment is nearly similar to that of the virulent gonorrhœa. The patient must observe the cooling regimen, lose a little blood, and take some gentle doses of salts and manna. The parts affected ought frequently to be bathed, or rather soaked, in warm milk and water, and, if the inflammation be great, an emollient poultice or cataplasm may be applied to them. This course will, in most cases, be sufficient to abate the inflammation, and prepare the patient for the use of mercury.
Symptomatic chancres are commonly accompanied with ulcers in the throat, nocturnal pains, scurfy eruptions about the roots of the hair, and other symptoms of a confirmed lues. Though they may be seated in any of the parts mentioned above, they commonly appear upon the private parts, or the inside of the thigh. They are also less painful, but frequently much larger and harder than primary chancres. As their cure must depend upon that of the pox, of which they are only a symptom, we shall take no further notice of them, till we come to treat of a confirmed lues[[173]].
Thus we have related most of the symptoms which accompany or succeed a violent gonorrhœa, and have also given a short view of their proper treatment; there are, however, several others which sometimes attend this disease, as a strangury or obstruction of urine, phymosis, paraphymosis, &c.
A strangury may be occasioned either by a spasmodic constriction, or an inflammation of the urethra and parts about the neck of the bladder. In the former case, the patient begins to void his urine with tolerable ease; but, as soon as it touches the galled or inflamed urethra, a sudden constriction takes place, and the urine is voided by spurts, and sometimes by drops only. When the strangury is owing to an inflammation about the neck of the bladder, there is a constant heat and uneasiness of the part, a perpetual desire to make water, while the patient can only render a few drops, and a troublesome tenesmus, or constant inclination to go to stool.
When the strangury is owing to spasm, such medicines as tend to dilute and blunt the salts of the urine will be proper. For this purpose, besides the common diluting liquors, soft and cooling emulsions, sweetened with the syrup of poppies, may be used. Should these not have the desired effect, bleeding, and emollient fomentations, will be necessary.
When the complaint is evidently owing to an inflammation about the neck of the bladder, bleeding must be more liberally performed, and repeated according to the urgency of the symptoms. After bleeding, if the strangury still continues, soft clysters, with a proper quantity of laudanum in them, may be administered, and emollient fomentations applied to the region of the bladder. At the same time, the patient may take every four hours a tea-cupful of barley-water, to an English pint of which six ounces of the syrup of marsh-mallows, four ounces of the oil of sweet almonds, and half an ounce of nitre, may be added. If these remedies should not relieve the complaint, and a total suppression of urine should come on, bleeding must be repeated, and the patient set in a warm bath up to the middle. It will be proper in this case to discontinue the diuretics, and to draw off the water with a catheter; but as the patient is seldom able to bear its being introduced, we would rather recommend the use of mild bougies. These often lubricate the passage, and greatly facilitate the discharge of urine. Whenever they begin to stimulate or give any uneasiness, they may be withdrawn.
The phymosis is such a constriction of the prepuce over the glans, as hinders it from being drawn backwards; the paraphymosis, on the contrary, is such a constriction of the prepuce behind the glans, as hinders it from being brought forward.
The treatment of these symptoms is so nearly the same with that of the virulent gonorrhœa, that we have no occasion to enlarge upon it. In general, bleeding, purging, poultices, and emollient fomentations are sufficient. Should these, however, fail of removing the stricture, and the parts be threatened with a mortification, twenty or thirty grains of ipecacuanha, and one grain of emetic tartar, may be given for a vomit, and may be worked off with warm water or thin gruel.
It sometimes happens, that, in spite of all endeavours to the contrary, the inflammation goes on, and symptoms of a beginning mortification appear. When this is the case, the prepuce must be scarified with a lancet, and, if necessary, divided, in order to prevent a strangulation, and set the imprisoned glans at liberty. We shall not describe the manner of performing this operation, as it ought always to be done by a surgeon. When a mortification has actually taken place, it will be necessary, besides performing the above operations, to foment the parts frequently with cloths wrung out of a strong decoction of camomile-flowers and bark, and to give the patient a drachm of the bark in powder every two or three hours.