THE
HOMEOPATtHIC GUIDE,
IN ALL DISEASES
OF THE
URINARY AND SEXUAL ORGANS,
INCLUDING THE DERANGEMENTS CAUSED BY
WITH A STRICT REGARD TO THE PRESENT DEMANDS OF
MEDICAL SCIENCE,
AND ACCOMPANIED BY AN APPENDIX
ON THE USE OF
E LE C T'RO-MAG N E TISM
IN THE TREATMENT OF THESE DISEASES,
BY
WM. GOLLMANN, M. D.
TRANSLATED, WITH ADDITIONS,
BY
CHAS. J. HEMPEL, M. D.
Fellow and Corresponding Member of the Homoeopathic Medical College of Pennsylvania;
Honorary Member of the Hahnemann Society of London, &c. &c.
PHILADELPHIA:
PUBLISHED BY RADEMACHER & SHEEK, No. 239 ARCH STREET.
NEW YORK:-WILLIAM RADDE, 322 BROADWAY.
1 855.




Entered according to Act of Congress, in the year 1854, by
RADEMACHER & SHEEK,
In the Office of the Clerk of the District Court of the United States, in and for the Eastern
District of Pennsylvania.
King & Baird, Printers, Sansom Street.




EDITOR'S PREFACE.
GOLLMANN'S work commends itself to the profession, as one
of sterling merit in more than one sense. In the first place,
it does not deal in unmeaning, incoherent symptoms, but is,
throughout, adapted to the present demands of medical
science as respects diagnosis, pathology, and a description of
all the characteristic pathognomonic signs of disease. And, in
the second place, the work is complete; it omits no important
or interesting fact, and presents such a classification of the
diseases of which it treats, as the rational mind can at once
accept as philosophical and satisfactory.
Such a work as Gollmann's will be particularly serviceable
to the few superficial and one-sided symptomatists still lagging
behind the great body of homoeopathic physicians, who are
constantly and earnestly pressing forward towards the goal
of scientific truth in the treatment of disease. It will convince the reader, provided conviction can at all be impressed
upon his mind, that disease is something more than a mere
agglomeration of symptoms, and that morbid conditions of
the system  may arise, where the highest exercise of the
reasoning faculty has to be brought into play, in order to
determine the real quality of a group of apparent phenomena.  How could we ever succeed in successfully treating




iv                   EDITOR'S PREFACE.
the various forms of secondary and tertiary syphilis, including almost every variety of disorganisation of the various
tissues, if we did not first take the trouble to trace these
disorganisations to their first causes, by means of the reasoning faculty guided by the Ariadnean thread of physiology
and pathology?  Let any physician undertake to treat a
syphilitic ulceration of the throat, syphilitic tubercles, exanthems, bone-pains, or syphilitic caries and necrosis, syphilitic
iritis, syphilitic epilepsy, or syphilitic cachexia, according to
mere symptoms, and then see where such treatment would
lead him. Why, the treatment could not even be commenced.
The symptomatic treatment of all such diseases is radically
impossible.  Scarcely any of the symptoms which characterise these diseases, have been reproduced in our provings
upon the healthy.  In the numerous cases of mercurial
poisoning, recorded in the books, a few  disorganisations
similar to those above named, have indeed, been observed,
but they are far, very far, from being sufficiently numerous
to serve as a basis for a strict symptomatic treatment. If the
treatment of these affections is not conducted according to
reason, but simply according to the law of outward or apparent similarity, which is a mere perception on the plane of
sense, it will not only remain nugatory, but the poison will
run its triumphant career until the organism falls a victim to
its virulence. I am well aware that there are still a few
ignorant pretenders in the homoeopathic school, who reject
the existence of all secondary and tertiary forms of the syphilitic disease; in corroboration of this statement, I may here
allude to a'writer in the Philadelphia Journal of Homeeopathy, a certain Adolphus Lippe, who, with a ridiculous
boldness, asserted that there was no such a thing as secondary or tertiary syphilis.   Homceopathic physicians are




EDITOR'S PREFACE.                   V
getting to be ashamed of the childish assumptions of such
scribblers, and, thanks to the more enlightened teachings
emanating from  individual physicians, from well-organised
homoeopathic colleges, and from the liberal portion of the
alloeopathic brotherhood, the time is fast approaching, when
homoeopathy will no longer be a separate and distinct system
of medical treatment, but the true formula of therapeutics,
to which all medical truths will tend as naturally as the
rivers converge in their common reservoir, the ocean.
Attention is directed to the appendix, on the use of electromagnetism in the treatment of sexual diseases. I am enabled
to corroborate, from personal experience, all that Gollmann
says, in praise of this great agent, and my friend, Doctor
D. D. Smith, of this city, who is in the habit of combining
electro-magnetism with homoeopathic treatment, and, for this
purpose, uses electro-magnetic lockets, batteries, &c., of his
own contrivance, is constantly obtaining the most brilliant
results from the use of electro-magnetism in sexual diseases,
of any form or degree of intensity.
In Gollmann's work, the symptomatic indications for the
use of particular remedies have been omitted. I have supplied them in the present translation, and trust that they will
prove an acceptable and useful addition to the original.
CHARLES J. HEMPEL, M. D.,
54 Bond Street.
New York, Sept., 1854.








AUTHOR'S PREFACE.
IN giving this work to the public, the author was neither
actuated by the desire of enriching the book-trade, nor by
the vain' glory of being heard in the vast forum of science.
He was simply moved by the deep conviction acquired by
years of observation and experience, in the exclusive treatment of diseases of the sexual and urinary organs, that these
diseases very frequently destroy all domestic happiness; that
they cause deep bodily and mental suffering, and prepare for
the sufferer a sad and distressing future.
Experience has likewise convinced him, that a satisfactory
knowledge of the origin and spread of these diseases, and of
the physiological, anatomical and morphological relations of
the organs which are the seat of the sexual and urinary
functions, will afford to rational and enlightened laymen
the most certain means of putting a stop to the spread of
these affections.
The author does not mean to imply, however, that he wrote
this work for laymen only; on the contrary, he feels confident, that physicians will likewise derive essential advantages
from this work, inasmuch as regard has been had to all the
demands of modern science, and all the recent physiological,
chemical, and pathologico-anatomical discoveries, have been
used as a basis in the composition of this treatise.
The author has, therefore, deemed it his duty, with consci



vii      l        AUTHOR'S PREFACE.
entious care and an independent, critical judgment, to combine
his own experience, with the knowledge contained in the best
and most recent writings concerning the treatment of this
disease; he mentions, with gratitude, the names of Ricord,
Sigmund, Zeisl, Wallace, Waller, Cazenave, Hebra, and
others, who have shed such brilliant light on the nature and
treatment of syphilitic diseases, and whose thorough investigations and observations in this respect, have constantly
served as a basis for his own studies.
This acknowledgment, of course, only applies to the scientific diagnosis, etiology and prognosis of these diseases, not
to the treatment. The treatment recommended by the author,
is strictly homoeopathic, and, on this account, differs considerably, from that proposed by the above-mentioned authors.
In describing the treatment, all those remedies have been
recommended, which, according to his notes, had been of
essential service to the author in the management of these
affections. The intelligent reader will at once perceive, that
these remedies have been selected with a certain discrimination, and with a strict regard to the actual forms of the
disease; whereas, less efficient remedies, or such as only
referred to particular symptoms, have been omitted. The
particular indication's of these few specific remedies had to
be left to the judgment of the attending physician, who has
to determine what remedies ought to be used in every special
case. It is only in diseases where a layman who is sufficiently
versed in homoeopathy, might safely prescribe for himself,
without the interference of a physician, that the principal
symptomatic indications have been given.  The manner in
which these remedies are to be administered, on such occasions, will be found briefly indicated in the subsequent introduction.




AUTHOR'S PREFACE.                    ix
The author has deemed it expedient to commence the
work with an account of the anatomical structure, and of the
physiological functions of the sexual and urinary organs.
Considering the high rank, which chemistry and the microscope occupy in modern medicine, the author deemed a chemical analysis of the healthy urine, and a microscopical account
of the spermatozoa which play such an important part in the
function of propagation, indispensable.
After furnishing these anatomical and physiological details,
which are equally important and interesting to the physician
and layman, the author enters upon the description of the
various diseases, The arrangament which has been followed
by him in this respect, requires a short explanation.
The author deemed it expedient to commence this work
with a description of the sexual diseases, because they occur
more frequently, and are more varied, than others. These
diseases are naturally divided into two classes, one of which
is composed of the diseases which are communicated by contact generally by being inoculated during the sexual act
by means of a virulent matter; the second class comprises
the diseases emanating from  mechanical causes, congenital
malformations, sexual excesses of all kinds.
In the first division, we have treated all such diseases as
owe their immediate origin to an impure coit; our classification of these diseases differs somewhat from the views of
other authors.  Such diseases as cannot be inoculated by
means of a contagium, have been ranged under the head of
simple venereal diseases.  These cases have been described
by Sigmund, as syphilitic blennorrhagia. To this class of
diseases belong the various cases of gonorrhoea, with their
direct and indirect consequences.




X                 AUTHOR'S PREFACE.
The second class of this extensive group of diseases, comprises those forms of disease which are endowed with an inoculable poison. These forms of disease are known under the
name of ulcerous syphilis, termed primary syphilis, as long
as the poison has not infected the general organism. From
the moment when the poison loses its local action, and, by
infecting the blood, developes constitutional symptoms, an
essential difference is perceived between these two forms of
disease. The disease now becomes a general or constitutional
syphilis, which is again distinguished in secondary and tertiary syphilis, each of which is characterised by striking
appearances.
The third class is composed of sexual diseases which cannot be traced to a contagium, but which have a great influence
on the happiness of mankind, and either weaken or destroy
the sexual power.  Onanism  and sexual excesses, which are
the most frequent causes of these diseases, have been dilated
upon with particular care, and we recommend this chapter to
the attention of our non-professional readers as a means of
guarding against a host of distressing maladies.
The diseases of the urinary organs form the last part of
the work.
The work has been enriched with an appendix on electromagnetism, which has recently played such an important
part in sexual diseases, and which we ourselves have employed
in so many cases with distinguished success. In this appendix
we have furnished a brief outline of the efficacy of this agent,
and of our method of using it; a method, from  which we
have derived the most brilliant results in the treatment of
sexual diseases.
In publishing this work, we have only thought of the weal




AUTHOR'S PREFACE.                        Xi
of our fellow-beings, and we shall deem ourselves sufficiently
rewarded for our trouble, if our efforts should contribute in
some slight degree to a limitation of diseases which so seriously impair the welfare of human society.
August, 1858.








INTRODUCTION.
IN order to facilitate the use of this work, we have deemed
it appropriate, for the benefit of laymen, to furnish a few
indications concerning the use of the agents which are recommended in this work, including rules for a repetition of the
dose, and for the alternate exhibition of two or more drugs.
Taking it for granted, that both laymen and physicians are
acquainted with the rules according to which homoeopathic
medicines have to be selected, and more particularly with the
fundamental law, that a remedial agent, in order to be homceopathic to a disease, must be capable of producing in the
healthy organism, a train of symptoms, similar to those of
the disease, we will at once pass over to the practical rules
concerning the exhibition of the drug.
As regards the dose, we never go above the sixth or seventh
potency. From the commencement of our practice, we have
had every reason to prefer this attenuation to any other.
We never adhere to one drug, if it is evident that no cure
can be expected from it. If one drug fails us, we resort to a
second, and even third. It seems to us a reprehensible practice, to adhere to the exclusive use of one drug, if this drug
evidently has no effect on the condition of the patient. In
obstinate cases, we do not hesitate to combine surgical means
with the homoeopathic treatment.




xiv                   INTRODUCTION.
Strict regard has to be had to the mental condition of the
patient.  In  some cases, the choice of an otherwise appropriately indicated remedy, is determined by the moral
condition of the patient. If the patient is disposed to lowness of spirits, we recommend Aurum; if to religious melancholy, Veratrum; if to a weeping mood, Pulsatilla, Ignatia,
Sepia; if of an irritable disposition, Bryonia, and if. very
nervous, Coffea.
Diet and regimen, are of particular importance under homoeopathic treatment. The patients ought to abstain from stimulants, spices, fat, and flatulent food, tea, coffee, wine, and all
other spirituous drinks.  Indigestible food, or food which
oppresses the stomach, such as goose, duck, pork, heavy
farinaceous diet, pastry, etc., have likewise to be avoided.
The success of a homoeopathic treatment is very much
interfered with by every thing that excites and disturbs the
mind, such as depression of spirits, books, company, or
theatrical representations that excite the senses.
A cure is promoted by cheerful surroundings, in the country, or in some open and pleasant part of the city; by
moderate bodily exercise, and abstinence from mental exertions. The repetition of the dose depends entirely upon the
nature of the case. Dangerous and intensely-acute diseases,
which run a rapid course, require a much more frequent repetition of the dose than chronic diseases that run a slow
course.
These few indications will probably suffice; in difficult or
doubtful cases, a physician will have to be consulted.




SECTION I.
ANATOMICAL AND PHYSIOLOGICAL DESCRIPTION OF THE URINARY AND
SEXUAL ORGANS OF THE MALE AND FEMALE.
THE urinary and sexual organs are so closely related to
each other, both as respects their original development and
the union of their secretory ducts, that, although performing
vastly different functions, they may, nevertheless, be treated
anatomically as one set of organs.  The same organ which
serves as an outlet to the urine secreted by the kidneys, is
likewise designed to carry, with a feeling of the highest
sexual delight, the fructifying semen of the male into the
vagina of the female, through which it is transmitted to the
inner organs of generation and gestation, where, after a
period of forty weeks, the future man, the lord of creation, is
developed in a most marvellous manner out of a drop of the
male spermatic fluid.
The Urinary Organs.
They consist of pairs of glandular organs which secrete
the  urine; of their excretory canals, the kidneys and
ureters, and of a single hollow organ in which the urine
collects, and which is termed bladder, which discharges its
contents through the urethra.
I. THE KIDNEYS.
The kidneys are two glandular bodies situated in the
lumbar region, and designed to secrete the urine. The right
kidney is somewhat lower than the left, to accommodate the
right lobe of the liver, which is situated above it.  Both
kidneys are surrounded by a fatty, loose cellular tissue,
which keeps them in place. In shape they resemble a bean,
the outer border being convex, the inner concave; the latter
2




10                    THE KIDNEYS.
is provided with a fissure, where the renal vessels enter the
organ, on which account this fissure is termed the gate of the
kidneys or hilus renalis. The structure of the parenchyma of
the kidney is very curious. If a longitudinal incision is made
into the kidney, a whitish triangular substance is discovered
with the naked eye, around which we perceive another
substance of a brown-red color.
Former anatomists termed the whitish mass the medullary,
and the brown-red substance the cortical substance of the
kidneys. But, thanks to the microscope, we now know that
the so-called medullary substance consists of an infinite
number of delicate tubes termed the tubes of Bellini; and
that the cortical substance is simply a net-work of vessels,
formed by the tortuous convolutions of microscopic twigs of
the renal artery, and designated as the tubes of Ferrein.
These tubes give origin to the tubes of Bellini, in whose
interior the urine is secreted. The number of these tubes is
enormous, but gradually decreases in consequence of these
tubes uniting at acute angles two by two, until their number
is reduced to two hundred, which form a sort of triangular
pyramid, known under the name of pyramid or cone of Malphighi.  There are about ten or fifteen of such cones in each
kidney, with rounded apices termed papille, and converging
towards the hilus of this organ.  The papillae, which are
the excretory ducts of the Malpighian cones, are surrounded
by short, membranous cups or infundibula, four or five of
which are united into a common cup or calyx, which calices
unite again in their turn to form the pelvis of the kidney.
The pelvis terminates in the ureter which enters the cavity
of the bladder.
The supra-renal capsules are  two spongy, glandular
organs of a yellowish-brown color, without excretory ducts.
They are situated in the upper end of each kidney, which
is covered by them as by a cup.  Their object is as yet
unknown.




THE URETERS.-THE BLADDER.                  11
II. THE URETERS.
These are two cylindrical membranous canals conducting
the urine from the pelvis of the kidney to the bladder. They
pass from the pelvis of the kidney to the inferior and posterior portion  of the  bladder, which  they enter, passing
obliquely through its muscular and mucous coat. They are
of the size of a goose-quill, but they are extremely dilatable,
as is seen in various cases of retention of urine, in the
passage of calculi from the kidneys, pressure occasioned by
tumors, and difficult urination.
III. THE BLADDER.
This is the largest of all reservoirs in the human organism
containing secretions. Its size varies with the age, sex, or
habits of a person, or according to the disease with which the
organ is affected. The female bladder is larger than the
male, which is supposed to be owing to the circumstance, that
the former is more liable to distention from the more frequent retentions of urine to which the female is exposed.
But there is another reason why women void the urine less
frequently than men; it is this, men drink more than women.
As regards age, old people have a larger bladder than young
persons; the former, owing to a blunted sensibility, do not
feel the want of urinating as often as the latter, and hence
they are enabled to retain the urine much longer than young
people. This leads to an increased distention of the bladder.
So far as habit has an influence on the size of the bladder, it
may be said that the bladder of those who are in the habit of
retaining their urine as long as possible, is larger than that
of persons who discharge it frequently, as soon as the least
desire to urinate is felt.  Morbid conditions of the bladder
may either occasion a considerable distention of this organ,
-as in retention of urine, or else an excessive contraction, so
that not even a few drops of urine can be retained in the
bladder.  When the bladder is full, it can be distinctly felt
above the symphysis pubis as high up as the navel.  Only
the upper and posterior portion of the bladder is covered by




12                    THE URETHRA.
the peritoneum, so that only the lower portion of the organ
can be cut into without injuring the peritoneal covering.
Posteriorly, the bladder is bounded by the rectum in the
male, and by the uterus in the female. To the lower surface
of the bladder in the male are attached the seminal vesicles
and the excretory ducts carrying the semen from the testicles,to the vesicles. The superior extremity of the bladder is
attached to the umbilicus by means of the urachus, a strong
fibrous band arising from the obliteration of the umbilical
vesicle, a canal that is found only in the foetus.
The internal surface of the bladder shows numerous folds
of the mucous membrane, which assume a smooth appearance
when distended; moreover, we discover numerous muscular
bundles, forming prominences or trabecula, and determining
the contractile power of the bladder.
At the lower extremity of the bladder we see three orifices,
those of the ureters and the opening of the bladder into the
urethra. This portion of the bladder is termed the neck of
the bladder.
The bladder is composed of three coats. The outer coat is a
continuation of the peritoneum, and is, therefore, a serous sac
covering the bladder only partially, as stated before; the
middle or muscular coat is composed of longitudinal and
circular muscular fibres, which cross each other. The third
coat is a thin mucous membrane, which dips into the urethra.
Besides these various parts, the bladder is furnished with
numerous nerves and blood-vessels.
IV. THE URETHRA.
The urethra is the excretory canal of the bladder, and is
solely formed of the cellular and mucous tissues of this organ.
The male urethra differing essentially from the female, they
have to be described separately.
The male urethra is a canal of from  six to eight inches
long, and from  two to three lines wide, but can be sufficiently dilated to admit of the passage of instruments of
four lines in size in operations for stone in the bladder.




THE URETHRA.                      13
The urethra commences at the neck of the bladder, passes
obliquely through the prostate gland forwards and downwards, takes a semi-lunar curve under the symphysis pubis,
ascends forwards and upwards, and, from  the root of the
penis, courses onwards to the tip of the glans along the bottom of the furrow formed by the juxta-position of the corpora
cavernosa. It is appropriately divided into three portions,
1st, the prostatic portion, which extends from the neck of the
bladder to the outer edge of the prostatic gland, and which
contains the so called caput gallinaginis or verumontanum,
an oblong triangular fold of the mucous membrane; 2d, the
membranous portion, about three-fourths of an inch in length,
narrow, very little dilatable, and not surrounded -by the prostate gland or the corpora cavernosa; 3d, the cavernous portion
of the urethra, which is surrounded by the corpora cavernosa,
and the lower part of which, forming an enlargement in consequence of its being enclosed by the corpora cavernosa, is
termed the bulbus of the urethra. The lower wall of this portion of the urethra is somewhat depressed, on which account,
the introduction of the catheter is frequently impeded, and,
if conducted with undue force, occasioning the much dreaded
perforations of the perinzeum.  When empty, the mucous
membrane of the cavernous portion is arranged in folds,
which accounts for its extreme dilatability. Previous to the
urethra reaching its external orifice, the lower side of this
canal expands into the so called fossa navicularis, in which
the first phenomena of gonorrhoea develope themselves.
The female urethra is only one inch and a half in length,
and has neither a prostatic portion, nor corpora cavernosa.
Females are without the prostate gland. The female urethra
is wider than the male; it can be dilated to six lines.  This
shortness and dilatability of the female urethra accounts, in
some respects, for the less frequent occurrence of stone in
females, and for the facility with which stone is taken from
the female  bladder without the operation of lithotomy.
For the same reason it is much easier and much less dangerous to introduce the catheter into the female urethra.




14               THE URINARY SECRETION.
The female urethra extends in the pelvic cavity downwards
and forwards, forming a Slightly convex curve, then courses
along the mesian line of the anterior'wall of the vagina,
passes forwards under the symphysis pubis, between the crura
of the clitoris, and ends between the labia minora, a few lines
in front of, and above the orifice of the vagina.
The Urinary Secretion.
The blood is conducted to the kidneys by their arteries,
and, after passing through a multitude of ramifications,
arrives at the cortical substance, where it is first transformed
into venous blood which the renal veins carry to the inferior
vena cava, and afterwards into urine, which passes from the
cortical substance into the tubes of Bellini of the medullary
substance and oozes from the orifices of the papillae, as may
be  distinctly seen by pressing upon the latter with the
finger.  From  the papillae the urine is received into the
infundibula, the calices, and lastly into the pelvis of the
kidney, whence, by its own weight, and by the movements
of the diaphragm  during respiration, it is pushed forward
into the ureters, and finally collects in the bladder which
expels its contents as often as the desire for it is felt.
The evacuations of the bladder take place in a similar
manner as those of the bowels.  Under the influence of the
will the transverse fibres of the membranous portion of the
urethra become relaxed, in consequence of which a similar
relaxation takes place with the fibres of the sphincter vesicae,
and the orifice of the bladder is opened.  Shortly after, the
transverse muscular fibres of the bladder compress it from
all sides; a similar compression is made by the longitudinal
fibres from  the apex to the fundus.  These contractions
which take place with great uniformity and regularity, and
are assisted by the voluntary action of the abdominal muscles, drive the urine towards the orifice of the bladder,
through which it passes into the urethra which is attached
to the bladder like a moveable tube to a syringe, and, being




THE URINARY SECRETION.                 15
a contracted and continuous canal of uniform  dimensions,
discharges the urine in a single, coherent stream.
The force with which the urine is expelled,-is about equal
to the force that would be required to burst the bladder, if
the.urine should be prevented, by some mechanical obstacle,
from being expelled.
The immediate expulsion of the urine is effected by means
of the muscular contractions of the bladder. But the contractions themselves are brought about by the action of the
nerves, a great many of which are distributed over the walls,
and more especially over the neck of the bladder; they proceed from the spinal marrow, and the absence or deficiency
of this nervous action causes paralysis of the bladder and a
consequent inability on the part of this organ to perform its
contractions.
One of the principal causes which excites the muscular
activity of the bladder, is the urine; it is the most natural
and the most frequent cause of its contractions.  It stimulates the walls of the bladder. According to the quantity
and quality of the urine, its stimulating effects are more or
less speedily perceived by the bladder.  This depends likewise more or less upon the sensitiveness of the inner surfaces
of the bladder, and upon the fact, whether one is in the
habit of holding the urine as long as possible, or of voiding
it as soon as the least desire for it is felt.
In young persons this sensitiveness is greater than in old
age. The contractions of the bladder in the young are much
more vigorous and rapid than in old people. In females the
sensitiveness seems likewise less, for the reason, probably,
that a feeling of modesty impels them to hold the urine gs
long as possible.  Individuals who lead a sedentary life;
literary men who, while their attention is rivetel to scientific
subjects, lose sight of the indications of t      Ider, are
enabled to hold the urine a long time on acco         diminished sensitiveness of the inner surfaces of this u
The forcible retention of the urine in the bladder, ucC.
to the natural desire of voiding it, may be productive of inc.




16              THE URINARY SECRETION.
culable mischief. The full bladder crowding upon the adjoining organs, a variety of distressing feelings are excited in
consequence; stinging pains are experienced in the urethra,
perinoeum, and at the neck of the bladder; anxiety, palpitation of the heart, sweat, and even fainting fits are experienced,
and the emission of the urine, if it is finally to be accomplished, becomes exceedingly difficult, or even a dangerous
retention of urine sets in. It is said that the celebrated
astronomer, Tycho de Brahe, perished at the table of Queen
Christina of Sweden, in consequence of suppressing a natural
desire of voiding tlp urine.
Foreign bodies in the bladder, such as stone, coagula, a
piece of a probe, diseases of the prostate gland, hypertrophy
of this organ, strictures of the urethra, spasms of the neck
of the bladder, irritate this portion of the bladder, increase
the sensitiveness and multiply the contractions of this organ.
The same effect is produced by inflammation of the bladder,
irritation of the bladder by foreign substances, which the
urine derives from the circulatory fluid, by the internal and
external use of Cantharides; such causes may occasion a
continual desire to urinate, without a drop of urine being discharged.
The irritability of the bladder may be increased, and frequent contractions of this organ may be occasioned by
various other diseases, such as painful hemorrhoids, diseases
of the rectum, cancer or polypus of the uterus, etc.
The rapidity of the flow of urine differs according to the
age and constitution of the individual. In old people the
flow is slower than in young persons.  In stricture of the
urethra the stream is frequently interrupted, and the discharge of the urine takes place drop by drop.  If the stream
rushes onward to a distance, we may regard this as a sign of
strength.
The size of the stream  depends upon the width of the
urethra and upon its dilatability.  In young persons the
stream is larger than in old people, During an erection the
stream is thinner, because the tension of the urethra prevents




PHYSICAL PROPERTIES OF THE URINE.             17
its full dilatation, and, besides, alters its course.  If the prepuce covers the glans too tightly, the urine accumulates in
the fossa navicularis, before being discharged.
Towards the close of an emission of urine, when the bladder is nearly emptied, the flow of urine slackens, and the
stream stops, afterwards reappears more feebly and for a little
while, again intermits and again makes its appearance.
These last contractions of the bladder are performed partly
by the muscular fibres of the bladder, partly by the muscles
of the perinseum. The dribbling which takes place in some
cases towards the end of the emission, which had been otherwise satisfactory as respects vigor and continuance, depends
upon a deficiency of muscular action.
The urinary secretion of the female differs somewhat from
that of the male.  The female urethra being shorter, the
stream  which it discharges is less vigorous.  The labia
minora direct it downwards, and, in order to prevent the
wetting the external pudendur and the thighs, females have
to spread their lower limbs more than males during the act
of micturition. The stream being moreover larger, females
are able to accomplish it in a much shorter time than males.
The greater width of the urethra may likewise be the cause
of the more sudden and involuntary emission of urine in the
case of females under the impulse of fright, fear, or in consequence of tickling, etc.
Physical Properties of the Urine.
The urine of the female contains more water and more
saline particles than that of the male.  In return the male
generally secretes a larger quantity of urine than the female.
Females are less subject to diseases of the urinary organs
than males.
The urine which is secreted within twenty-four hours,
weighs from'three to five pounds. This quantity varies more
or less according to the quantity of liquid that a person
drinks in that period of time. Beverages which contain carbonic acid increase the secretion of urine; spirituous drinks




18        PHYSICAL PROPERTIES OF THE URINE.
diminish it. Various plants, and even nutrient vegetables,
such as parsley, potatoes, beer, and such drugs as colchicuml, digitalis, turpentine, saltpetre, bicarbonate of soda,
cream of tartar, cantharides, etc., promote the secretion of
urine by virtue of their specific action upon the kidneys. In
the winter season, and in cold climates, more urine is secreted
within twenty-four hours than in warm climates where the
cutaneous exhalation is more abundant. This shows that the
action of the skin and that of the kidneys are in alternate
relation to each other.  Children emit a large quantity of
urine, which is pale and clear as water. Old people secrete
a comparatively smaller quantity of urine, which is darker,
and contains a good deal of urate and phosphate of lime.
In diseases, the secretion of urine may either be decreased
or increased, or even entirely suppressed. In diabetes mellitus the urine is not only secreted in an excessive quantity,
but it likewise contains a good deal of saccharine matter
which may be obtained from  the urine in the shape of crystals by evaporating the liquid. In diabetes insipidus, and in
pulmonary phthisis, the urinary secretion is likewise increased;
in fevers, in diseases of the liver and heart, and more particularly in dropsy, it is diminished, and in cholera and disorganizations of the kidney it is entirely suppressed.
The color of healthy urine is of a pale or orange yellow.
In the morning the urine is generally darker, more saturated; this darker color is occasioned by the uroxanthin, a
coloring matter of urine. In fevers, in diseases of the liver,
in arthritis and  rheumatism, etc., the  urine frequently
assumes a red-brown, dark-yellow, greenish, or some other
color, and deposits a quantity of sediment.  The normal
chemical constituents of the urine are sometimes increased,
at other times decreased in disease. In nervous diseases, in
violent nervous pains, hysteria, megrim, the urine is generally pale and reacts less as an acid.
Several kinds of food and drugs modify the color of the
urine.  Beets, the fruit of the cactus opuntia, campeachy
wood, Peruvian balsam, cochineal, madder, impart a reddish




PHYSICAL PROPERTIES OF THE URINE.            19
color to urine; rhubarb tinges it yellow; indigo and Prussian
blue tinge it greenish and blue.
Urine, which is clear and transparent in health, is apt to
become cloudy and turbid in disease. This cloudiness of the
urine is partly owing to the anomalous chemical constituents
of the urine, partly to the admixture of organic substances,
such as: mucus, albumen, fat, blood, semen, pus, etc.
The odor of recently-voided urine is peculiarly aromatic,
and not very disagreeable. After standing for a while, and
cooling, it loses this odor, and assumes the characteristic
smell of urine. Afterwards, according as the urine is more
or less disposed to become decomposed, the smell changes to
sour, and finally becomes ammoniacal and fetid.
In hysteria and other'nervous affections, urine has no odor;
in Bright's disease, which is generally accompanied with
dropsy, and where the urine contains a good deal of albumen,
it smells like broth; in diabetes mellitus it has at first an
insipid smell which, after the sugar begins to fertnent,
changes to the odor of alcohol; in blennorrhoea of the
bladder and in retention of urine, it has an offensive smell
as soon as it is emitted.
The ordinary smell of urine is likewise altered by certain
kinds of food or drugs.  Asparagus, cabbage, cauliflower,
impart a very unpleasant smell to urine; turpentine, rosin,
balsam of copaiva or other kinds of balsam, give it the odor
of violets; juniper berries, valerian, garlick,. castoreum, musk,
impart to the urine the odor which is peculiar to these substances.
A  peculiar and not very frequent phenomenon is the
shining of the urine. In one case this shining was observed
in the winter-season immediately after the urine had been
voided; it shone for half a minute like a fire-fly, after which
the luminous appearance diminished. In another case the
urine was observed to shine after it touched the wall or the
soil; in some cases this phenomenon has been observed for
two or three minutes in succession. This shining of the urine
is a natural property of this fluid in the case of the civit-cat,




20             THE SEXUAL ORGANS.-MALE.
the iltis, and other animals. This shining probably results
from the presence of phosphorous nitrogen, arising from the
deoxydation of phosphoric acid and carbon contained in the
urine.
The chemical constituents of the urine in its normal or
morbid state, and the various changes which this fluid undergoes, will not be described in this work, which was not designed
to convey this sort of information.
The Sexual Organs.
These organs are similar, in their arrangement, to the urinary organs. Their destination is not, like that of the other
viscera, to preserve the individual, but to propagate the species. Their constituent parts are: a gland which secretes
the semen, and  its excretory duct;  a  reservoir which
receives and matures the semen, and a canal going to the
surface of the body.  The division of the sexual organs into
external, middle and internal, is not applicable to both sexes;
for that portion of the male organs, which corresponds to the
internal female organs, is situated outside of the abdominal
cavity.  It would be more appropriate to class the sexual
organs under two heads, organs of generation and organs of
fecundation; the former prepare the seminal fluid, the latter
perform the function of fecundation during the sexual act.
The male organs of generation are the testicles, spermatic
duct and seminal vesicles; the female organs are: the ovaries, Fallopian tubes and uterus. The male organs of fecundation are: the penis; and the female organs: the vagina
and vulva.
I. THE MALE SEXUAL ORGANS.
The testicles, which secrete the semen, are the most essential portion of the organs of generation; they determine the
sexual character of the man; their loss annihilates his generating faculty, and either renders nugatory, or effaces all his
other sexual attributes. They are attached to the spermatic
chords, and lie close together in the bottom  of the scrotum,




SEMINAL DUCTS; OR, VASA DEFERENTIA.            21
the right one a little higher than the left; they consist of
the testicle properly speaking, and of the epidydimis.
The testicle has an ovoid, somewhat flattened shape. It is
not quite perpendicular, its upper extremity being somewhat
turned forwards and outwards, its lower extremity backwards
and downwards, its anterior border somewhat downwards,
and its posterior upwards.
The epidydimis is laid alongside the posterior border of the
testis like a clasp; its larger, upper extremity is termed the
globus major, and its thinner, lower extremity, which unites
with the vas deferens, is termed the globus minor or cauda.
The testicle is surrounded by a fibrous membrane which
determines the shape of the testicle, and, from its inner surface sends off a number of processes which dip into the substance of the testicle, and divide it into several hundred
lobules, each of which is composed of several exceedingly convoluted seminiferous tubuli.  These tubuli are about T~ of
an inch in diameter; they are united by cellular tissue and
blood vessels, and constitute the parenchyma of the testicle.
This parenchyma is very soft, and has the appearance of
yellow or grey marrow deposited between the above-mentioned
processes of the surrounding membrane. The marrow is composed of the seminiferous tubuli or ducts of which about 800
have been counted, and the united length of which amount to
about 850 to 2500 feet.
II. THE SEMINAL DUCTS; OR, VASA DEFERENTIA.
These are to the organs of generation what the ureters are
to the bladder. Each vas deferens extends from the cauda
of the epidydimis, of which it forms the continuation, to the
seminal vesicle of the same side. At first it forms a convoluted duct, after which it passes upwards in a direct course
along the posterior part of the spermatic cord, and along the
spermatic canal to the internal abdominal ring.  From the
ring it is reflected inwards to the side of the fundus of the
bladder, and descends along its posterior surface, crossing the
direction of the ureter to the inner border of the vesicular




22      SPERMATIC CORD.-VESICULMA SEMIMALES.
seminalis, approaching that of the opposite side.  It is
through this open triangular space, where the bladder and
the rectum meet, that the bladder has to be cut into from the
perinaeum in the operation of lithotomy.  The vas deferens
terminates at the base of the prostate gland by uniting with
the duct of the vesicula seminalis, aad constituting the ejaculatory duct.
The structure of this canal is remarkable on account of the
thickness of its parietes, which is so great that the canal can
be easily felt in the spermatic cord.
III. THE SPERMATIC CORD.
It is composed of arteries, veins, lymphatics, nerves, the
excretory duct of the vesicle, and the investing tunics. It
commences at the internal abdominal ring, where the vessels
of which it is composed, converge, and passes obliquely along
the spermatic canal; the cord then escapes at the external
abdominal ring, and descends through the scrotum to the posterior border of the testicle. The left cord is somewhat longer
than the right, and permits the left testicle to descend a little
lower than the right. It is covered by a smooth fibrous membrane which it has in common with the external tunica vaginalis testis.  This membrane extends through the inguinal
canal down to the bottom of the scrotum, in the shape of a
cylindrical bag which is enlarged below, and lines the spermatic cord and testicle of one side, without, however, forming
a cavity; but, by its internal surface it adheres to the spermatic cord, and is united to the testicle by means of the
tunica vaginalis. Externally the cord is surrounded by a
thin muscular expansion capable of elevating the scrotum
towards the abdominal ring.
IV. THE VESICULA SEMINALES.
These are two lobulated and somewhat pyriform bodies
situated on the under surface of the base of the bladder, and
converging towards the base of the prostate gland. They
are about two inches in length. Their upper surface is in




PROSTATE GLAND.-COWPER'S GLANDS.             23
contact with-the base of the bladder; the under side rests on
the rectum. Each vesicula is formed by the convolutions of
a single tube, which gives off several irregular coecal branches.
It is enclosed in a dense fibrous membrane, and is constricted
beneath the prostate gland into a small excretory duct. The
vas deferens, somewhat enlarged and convoluted, lies along
the inner border of each vesicula, and is included in its fibrous
investment. It communicates with the duct of the vesicula,
and forms the ejaculatory duct. This is about three quarters of an inch in length, and running forward, first between
the base of the prostate and the isthmus, and then through
the tissue of the verumontanum, opens upon the mucous membrane of the urethra, near its fellow of the opposite side, at
the anterior extremity of that process.
V. THE PROSTATE GLAND.
This gland resembles a Spanish chesnut both in size and
form. It surrounds the commencement of the urethra for a
little more than, an inch of its extent, and is situated upon
the rectum, through which it may be felt with the finger. It
consists of three lobes, two lateral and a middle lobe or
isthmus, which are united together by a firm celular membrane that surrounds the whole gland.  Its surface is smooth.
The mucous membrane of the urethra being continuous with
that of the excretory ducts of the gland, an inflammation of
the urethra may spread onward to, and involve the gland.
VI. COWPER'S GLANDS.
These are two small lobulated and somewhat compressed
glands of the size of peas.  They are situated in front of,'and close behind the prostate gland, above the corpus spongiosum of the penis, to which they are attached by strong
fibres. They consist of small lobules and vesicles, the excretory ducts of which unite into a larger duct three-fourths of
an inch in length, and opening upon the lower surface of the
urethra.
Their destination is scarcely any better known than that




24                     THE PENIS.
of the prostate gland; and, on account of their small size,
they are not of much practical importance.
VII. THE PENIS.
The penis is the medium of sexual union between the male
and female.  The urethra being the canal through which the
male semen is discharged into the internal sexual organs of
the female: it is one of the constituent parts of the male
organs of generation. If the urethra had no other destination than merely to facilitate the escape of the urine from
the bladder, a simple orifice at the surface of the body, as in
the female, would be sufficient.  Next to transmitting the
semen, the penis discharges another very important mechanical function, viz: to excite the sexual tone in the female
organs.  This exultation of the female organs is an essential
condition for the reception of the semen by the female.
Hence the penis has to be so arranged as not only to be
capable of erection but also of elongation.  Otherwise it
could not possibly exercise its sexual stimulation either by
pressure or friction. The penis is provided with three dilatable bodies by means of which this purpose is accomplished.
The entire penis is covered by the skin, and, at its root, is
suspended to the mons veneris by a suspensary ligament.
The skin is continuous with that of the mons veneris and
scrotum, and with the skin of the adjoining parts. It is a
thin skin, and is united to the subjacent parts by means of a
loose cellular tissue which is capable of dilatation and extension. At the anterior extremity of the penis the skin is
reflexed inwards as far as the fossa behind the glans; this
reflexed portion of the skin changes to mucous membrane,
and is reflexed back again over the glans. This anterior
portion of the outer skin covering the glans is thinner, very
delicate, and provided with a looser cellular tissue; it is
termed the foreskin or prepuce, and generally covers, and
even overhangs the tip of the glans, although it can be
drawn back as far as the groove behind the glans. The prepuce is composed of the outer skin, and the subjacent mucous




THE PENIS.                      25
membrane; these two parts are separated by loose cellular
tissue. In front, opposite the orifice of the urethra in the
glans, the foreskin has a roundish slit of different size; the
posterior half of the prepuce is composed of its inner layer,
which is always more closely adhering and tighter than the
outer skin or layer, and is united to the glans except in the
middle, where it is attached by the fraenulum to the urethra.
On the inner side of the internal layer we have from two to
three rows of follicular glands, which secrete a fatty, thick,
strong-smelling substance of a white-yellow color, the abnormal accumulation of which, especially with a tight prepuce,
sometimes occasions inflammatory symptoms, with  small
ulcers on the glans, balannorrhoea, which might be mistaken
for syphilis by uninformed persons.  If the prepuce is so
long that it hangs beyond the glans like a tube, and if the
foreskin is moreover so tight that it cannot be drawn back
over the glans, we term this condition phymosis, which, in
consequence of impurities accumulating behind the prepuce,
or in consequence of an excessive secretion from the follicles,
may lead to a painful inflammation of the mucous membrane,
an inconvenience which Turks and Jews endeavor to prevent
by circumcision.  The suspensory ligament of the penis is
composed of a bundle of strong fibres, of a triangular, flat
shape, going from the symphysis pubis to the root of the
penis.
The corpora cavernosa of the penis on its dorsum or sides,
are composed of an exceedingly composite tissue of bloodvessels anastomosing with wide orifices; they are surrounded
by a firm, fibrous membrane, sending processes into the tissue,
by means of which it is divided into meshes within which the
blood-vessels are embedded. There are two corpora cavernosa, one on the right, and the other on the left side, arising
posteriorly by two roots from the inner borders of the ascending rami of the ischia. In front of the symphysis pubis
both become enveloped in a fibrous covering, and, by a vertical, fibrous septum, are divided into two halves. Inferiorly,
where they unite, a shallow furrow is formed, through which
3




26       THE FEMALE SEXUAL ORGANS.-OVARIA.
the urethra courses. The anterior extremity of the corpora
cavernosa forms, a truncated cone which is surrounded by the
glans. Superiorly another furrow is formed, through which
the dorsal vein of the penis, two arteries and nerves course.
The distribution of the blood-vessels in the corpora cavernosa
is different from that in other parts, and is principally calculated to admit of a speedy transmission of the fluid from the
arteries into the veins. The glans forms the anterior extremity of the penis, and somewhat represents a truncated
cone, the apex of which contains the orifice of the urethra.
Behind the glans we discover a furrow, termed corona glandis.
The surface of the glans is covered by a delicate mucous
membrane, which is richly provided with follicles in the region
of the corona. The tissue of the glans is spongy, erectile,
like that of the corpora cavernosa. The glans seems to be a
continuation and enlargement of the corpora cavernosa.
The Female Sexual Organs.
I. OVARIA.
The ovaria are to the female that which the testes are to
the male: germ-preparing organs, and, therefore, the most
essential portions of the organs of generation. Their shape
and structure remind one of the testes, and, indeed, the
ancients called them the female testes.  They are two oval
bodies, somewhat compressed from before backwards, and not
quite as large as the testes. They are situate horizontally
in the entrance of the small pelvis, in a fold of the broad
ligaments, behind the Fallopian tubes, one on each side of
the uterus. They are of a whitish color with a reddish tinge;
previous to pubescence their surface is smooth, but after
menstruation, conception or parturition, it becomes cracked.
Immediately previous to the first menses their size is the
largest; as the female advances in age, their size and shape
becomes altered; they become thinner, harder, more elongated, and in old women they shrink up to one third of their
original volume.
The ovaries are connected to the upper angles of the




THE UTERUS.                     27
uterus at each side by means of a rounded cord, the ligament
of the ovary. By the opposite extremity they are connected
by another and a shorter ligament to the fimbriated extremity of the Fallopian tube.
Each ovary is composed of a firm, whitish, shining fibrous
covering which is intimately connected with the peritoneum;
and of an internal substance composed of a number of
blood-vessels and dense cellular tissue, the parenchyma of
the ovary. This parenchyma contains from twelve to twenty
perfectly closed membranous sacs, the G-raafian vesicles,
each of which is composed of three parts: 1, the vesicle
properly speaking which is about three lines in diameter; its
outer firm envelope adheres to the parenchyma, and its fluid
interior contains a number of small granules which accumulate near the surface on the vesicle and constitute the ovisacs
or receptacles of, 2, the human ovum, which is scarcely visible
to the unarmed eye. The peripheral portion of the ovum is
composed of albumen, the inner portion of the yolk, with
numerous larger and smaller granules. In this yolk, but
somewhat near the surface, we find 3, the s6-termed gerinztal vesicle discovered by Purkinge; it is transparent,
rounded, surrounded by a very delicate envelope and containing in its interior a clear fluid, in which we observe
through the microscope the germinal spot discovered by
Wagner.
II.  THE UTERUS.
This is a single hollow organ, in which the development of
the ftetus takes place. It has an oblong, pyriform shape.
Its broad, thick fundus is directed upwards, its fiat, cylindrical neck downwards. The lowest portion of the neck projects forwards into the vagina, and is the vaginal portion of
the uterus.  The posterior surface of the body of the uterus
is flatter than the posterior, and the broad ligaments are
attached to the sides. The round ligaments are real prolongations of the substance of the womb, emanating from the
sides of the fundus in the shape of rounded cords enclosed in




28                    THE UTERUS.
the anterior layer of the broad ligaments, extend through
the inguinal canal to the external pubic region, and are lost
in the superficial fascia.
In proportion to the size of the organ, the cavity of the
uterus is small; in females who have not yet borne children,
the shape of this cavity resembles a triangle whose sides are
bent inwards. The basis of the triangle corresponds to the
fundus of the uterus. At the angles of the basis are the
orifices of the Fallopian tubes. The summit of the triangle
represents an elongated narrow canal with two openings, an
upper one, the interior orifice, and a lower one, the exterior
orifice of the womb. In virgins the exterior orifice is a transverse slit; but in females who had children, the orifice is
rounded.
The substance of the uterus is composed of three layers.
The outer layer, which is a duplicature of the peritonseum, is
only seen on the fundus and body of the organ; the inner
layer is a mucous membrane continuous with that of the Fallopian tubes, and forming within the neck of the uterus two
or three longitudinal folds, from which smaller folds branch
off on the sides, the whole of which resemble the stem and
winged extremity of a feather, and are termed arbor vitae.
Between the little folds we perceive larger mucous glands
which are very frequently of the shape of rounded, closed,
prominent vesicles, and in this condition are termed ovula of
Naboth. In the uterine cavity proper, the mucous membrane
is without any folds and is dotted with small shaggy flocks
and innumerable, tubular, perpendicular follicles acquiring a
considerable development during pregnancy.  The middle
layer constitutes the hard genuine substance of the uterus.
The size, shape, position and condition of the uterine cavity
undergo numerous modifications in the different ages of the
female.  The uterus of a young woman is two and a half
inches long; it has a breadth of sixteen lines at the fundus,
and of only nine lines at the neck. After parturition the
uterus loses forever its virginal condition, and, on, account
of the relaxation of its ligaments, descends somewhat in the




FALLOPIAN TUBES.-VAGINA.               29
pelvic cavity. This likewise takes place transitorily during
every monthly period.
The pressure which is exercised upon the adjoining organs
by the impregnated uterus, accounts for the derangements of
the alvine and urinary functions, the difficulty of breathing,
the jaundice, the swelling and numbness of the feet, the distension and hardness of the abdomen, and the consequent
-tendency of carrying the upper part of the body backward.
The most remarkable changes of form take place in the
neck and vaginal portion of the uterus. Having been once
distended by pregnancy, the. external orifice of the uterus
never again assumes its flattened shape with the transverse
split, but becomes rounded, with the lips standing apart, and
the margins notched inconsequence of the lacerations which
the external uterine orifice suffers during a first parturition,
and which impart to it a cartilaginous consistence.
III.  THE FALLOPIAN TUBES.
These tubes are given off from the upper portion of the
uterus, and extend to the sides of the small pelvic cavity.
They are five inches in length.  Enclosedin the broad ligaments, they at first run in a straight line, and afterwards form
an outward curve with fringed or fimbriated extremities, as
if they had been bitten off. The fringes, when erect, form a
funnel-shaped space, which embraces the ovary at the moment
when an ovum escapes from a Graafian vesicle.  The ovum
passes through the tube into the uterus, in whose cavity it
either disappears by absorption, or is changed to a foetus. In
rare cases it happens that the ovum remains within the
tube, and is there transformed into a foetus. This kind of
pregnancy is termed Fallopian pregnancy, which always terminates unfavorably.
IV.  TEE VAGINA.
The vagina is a canal which leads from the uterus to the
external pudendum and receives the penis during coit. It is
dilatable and membranous, from five to six inches long, and




30.            THE EXTERNAL PUDENDUM.
fifteen to twenty lines wide, and situated between the bladder
and rectum. Its course is slightly downwards and forwards,
corresponding to the axis of the small pelvis in which it is
imbedded.  The upper extremity forms a circular cul-de-sac,
embracing the neck of the uterus, and somewhat larger posteriorly; the anterior extremity forms a longitudinal split,
terminating in the external pudendum. Its position between
the rectum and bladder, and its proximity to the urethra,
explains how one and the same cause may affect all these
parts together; how, for instance, a violent and continued
pressure of the head of the child during labor may cause a
sloughing of these parts, and a consequent recto or vesicovaginal fistula.
The walls of the vagina are about one line in thickness,
dilatable and relaxed, and are composed of two closely interwoven membranes. The outer membrane is a firm cellular
membrane, traversed by a numerous network of veins; the
internal membrane is a delicate mucosa, continuous with that
of the uterus and that of the labia minora. On the anterior
wall of the vagina, this mucous membrane forms on both
sides of a longitudinal sutsure numerous transverse rugae,
more particularly at the entrance of the vagina. These
rugse disappear more and more by coit and parturition.
The mucous membrane is furnished with a multitude of follicles. Near the entrance the vagina is surrounded by circular
muscular fibres, termed constrictor vagine; these fibres start
from the lower side of the symphysis pubis, and coalesce
with the. constrictor ani. Numerous blood-vessels and nerves
course along with the vagina.
V. THE EXTERNAL PUDENDUM.
First, we notice the so called mons veneris, which is a
prominence situated in front of the symphysis pubis, is composed of adipose cellular tissue, and covered with frizly hair.
The labia majora are two thick membranous folds, constituting the sides of the external pudendum. They communicate with the integuments of the mons veneris and those




THE EXTERNAL PUDENDUM.                 31
of the perinseum; at the posterior extremity, close to the
entrance of the vagina, there is a small depression, termed
the fossa navicularis.  Externally the labia majora consist
of a delicate, rather hairy skin, continuous with that of the
thighs and pubic region; the inside covering resembles a
mucous membrane, is thin and smooth, reddish in young, and
pale in old age.  Both the outer and inner sides enclose a
loose adipose cellular tissue and a number of mucous follicles
opening on the inner side. In the virgin both lips are closely
united, forming a longitudinal slit; after frequent coit and
parturition, they remain permanently separated more or less
by the labia minora, which protrude between the former.
The labia minora or nymphwe, likewise constitute two membranous folds, emanating from the labia majora. Posteriorly
they are closer together than anteriorly; externally they terminate in a cock's-comb-shaped, indented, free margin. They
consist of a delicate, red mucous membrane, richly provided
with nerves, and hiding between its external and internal
layers a loose cellular tissue and a number of mucous glands.
At the anterior and superior extremity, each lip divides into
two crura, the lower ones of which unite with the clitoris, and
and the upper ones of which, above the clitoris, coalesce,
forming a sort of cap or prepuce.
It is only in females in whom they do not protrude, that
the labia minora have the rosy color of a mucous membrane;
if protruding, they become drier, harder, assume a brown color,
and, if the sexual organs are abused, they sometimes become
so relaxed that they hang down like flaps of an inch in width.
Among the women of the Hottentots and Bosjemans, they
are from six to eight inches long, and have been described
by travellers as aprons. Among certain tribes of northern
Africa, they are habitually so long that' they have to be
cut off.
The clitoris is a body that resembles the male penis. It
consists of two corpora cavernosa, has a glans, prepuce and
double fraenulum, but no meatus urinarius. The clitoris is
situated below the anterior commissure of the labia minora,




32             THE EXTERNAL PUDENDUM.
and is covered by the prepuce.  It arises by two crura
from the ascending rami of the ischia, to each of which an
erector muscle is attached; the corpora cavernosa unite
under the symphysis pubis, terminating in the glans of the
clitoris which reaches beyond the prepuce in the shape of a
roundish body of the size of a pea. Superiorly the clitoris
is united to the symphisis pubis by means of a frmenulum,
and inferiorly to the labia minora by means of another fraenulum.
This portion of the pudendum  is richly endowed with
nerves and vessels, and is the principal seat of the thrill
during coit.
In the southern climate the clitoris is larger than in the
temperate and frigid zones. Among the women of Abyssinia, among the Mendingas and Ibbos, its size is so considerable that it is a popular usage to clip off a part of it. When,
after the conversion of the Abyssinians to Christianity, the
circumcision of the women was abolished as a remnant of
paganism, the men rebelled against this innovation, and the
opposition was not appeased until a surgeon was sent by the
propaganda from Rome, who declared the restoration of the
former custom necessary.
Among our own women the clitoris is sometimes so large
that a belief in the existence of hermaphrodites has been
suggested by this abnormal size; that is to say, female sexual
organs with a male penis, a malformation which has induced
an unnatural satisfaction of the sexual instinct between two
women. In the case of a woman of thirty-five years, the
clitoris had the size of the penis of a boy of two years, and
was capable of erection and abnormal sexual satisfaction; in
another case the clitoris had the ordinary thickness, but four
times its natural length; all the other characters of the
female pudendum were preserved in their natural form.  In
this case the clitoris was an hindrance to sexual intercourse,
and was amputated with success.
The triangular space between the clitoris, meatus urinarius,
and labia minora, is termed the vestibule of the vagina.




PHYSIOLOGY OF SEXUAL FUNCTIONS. SEXUAL ACT.  33
The meatus urinarius forms a small, pad-shaped ring, and
is situated below the clitoris and above the entrance to the
vagina.
In virgins, the greater portion of the vaginal orifice which
is covered by the labia, is closed by the hymen. This hymen
consists of two folds of the mucous membrance, and has
various shapes; generally it is semi-lunar, with a concave
margin. Sometimes it is circular, covering the whole orifice,
with a perforation in the centre. Very seldom the vagina is
closed entirely, which would prevent the discharge of the
menstrual blood.  Generally the hymen is torn during the
first sexual embrace, and its remnants are termed the myrtleshaped warts.  In some cases, however, the hymen remains
intact after repeated intercourse, and I myself have been
obliged in the case of a primipara, to separate the hymen
with the knife during the act of parturition.
Physiology of the Sexual Functions.
The highest object of the sexual functions is the propagation of the species. This is effected by the sexual act and
consequent fecundation.
I. THE SEXUAL ACT.
The object of the sexual act 6n the part of man is, to discharge the semen into the sexual organs of the female, and
on the part of woman to receive the seminal fluid.  The
sexual delight which precedes the act, increases in proportion
as the contact of the sexual organs becomes more intimate.
By merely touching the mammae, both the mammae and the
penis sometimes become erect, the woman experiences shooting stitches in the mammae and abdomen, palpitation of the
heart, trembling, chills; excitable or debilitated females are
even seized with convulsions.  The penis and the tissue of
the clitoris become erect, and the constrictor muscle of the
vagina dilates its orifice and changes it to a rounded opening.
On inserting the penis into the vagina, the nerves of the
clitoris are first touched by the glans, and the sexual delight




34                    FECUNDATION.
is increased; passing onward under the clitoris, the glans
penetrates with some difficulty between the prominences of
the vestibule, the dorsum of the penis comes in contact with
the glans of clitoris, and the whole space of the vagina is
filled up by the penis.
In virgins the sexual delight is increased even by the pain
which the tearing of the hymen causes; the narrowness and
the pleasant temperature of the vagina, its prominences here
and there, and the rhythmical contractions of the constrictor
vaginae, facilitate the delightful friction of the penis; the
voluntary movements of the penis, and the involuntary action
of the erector muscles, increase the excitement to the highest
degree, which terminates in the male with the emission of the
semen, and in the female after the penis had been withdrawn
from the vagina, or the penis has become relaxed. By means
of the vaginal friction, the orifice of the womb ma.y possibly
be opened so that the semen is enabled to reach the interior
of the womb, but in most cases it flows back again out of the
vagina.
The emission takes place involuntarily by the contraction
of the ejector muscles; after the emission is terminated the
stimulation of the nervous tissues generally ceases, as well as
the afflux of blood to the arteries of the penis; the blood
again flows backwards through the veins, and the penis
becomes relaxed. The erection of the clitoris likewise ceases.
This sexual orgasm  is frequently succeeded by languor,
drowsiness, sadness, irritable mood; hence the proverb:
" omne animal post coitum triste," after coit every animal
feels out of humor.
II.  FECUNDATION.
In order that fecundation or conception may take place, it
is necessary that the ovum should actually be touched by the
semen, and not merely by the seminal aura; and, secondly,
that the semen should contain a sufficient number of spermatozoa. We will now proceed to consider these elements and
laws of conception more in detail.




THE MALE SEMEN.                     35
The Male Semen.
On coming out of the urethra, the male semen consists of
a thin fluid which is soon succeeded by a fluid of more consistence, and forms a mixture of the secretions of the testicles,
spermatic ducts, seminal vesicles, Cowper's glands, of the
prostatic fluid, and probably of the mucus of the urethra.
As was said above, the semen consists of a thin milky, and of
a thick, viscid and albuminous portion.  If the semen is
exposed to the air, the fluidity of these elements increases, and
a more intimate commingling takes place. The semen spreads
a peculiar odor, has an alkaline reaction; its chemical constituents are water, mucus, albumen, natrum, phosphate and
muriate of lime, phosphorus, and a peculiar animal substance,
termed spermatine. If the semen is seen through the microscope, we discover floating in it small filiform bodies which
have been termed spermatozoa. They exist in every kind of
animal semen, and are so characteristically shaped, that their
presence is a sure indication of the character of the fluid. In
the spermatozoa of the human semen, one extremity is large,
the head, to which is attached a thread-shaped prolongation,
the tail; their length is from  A to  1 of a line.
If magnified to three or four hundred times their original
size, in the recent semen, they move about very briskly in
every direction; they agitate their tails, and even avoid small
obstacles in their course. Gradually their movements become'
slower, and finally cease altogether. The duration and liveliness of these movements depend upon the strength of the individual from whom the semen came. The strength or debility
of these spermatozoa indicatesa higher or lower degree of
fecundating power. They first show themselves at the age of
pubescence, and probably disappear again with the complete
extinction of the sexual power. Their complete absence
indicates an inability on the part of man to fecundate the
female ovum.




36                 THE FEMALE OVUM.
The Female Ovum.
The ovaries, the artificial removal or the destruction of which
by disease iA just as surely followed by sterility as the removal
of the testicles in the male, contain from 12 to 20 ovula
which we have described previously. In little girls the ovaries
are very small and light, but towards the period of pubescence they increase rapidly in size and weight; at the critical
period termed the period of involution, when the menstrual
flow ceases, they, together with the ovula, disappear. Each
menstrual period is characterized by an increased determination of blood towards the ovaries, which is particularly perceptible round the ovum that has reached the highest degree
of maturity and which then reddens, swells and escape from its
capsule. This little ovum is seized by the fimbriated extremity
of the Fallopian tube and conducted to the uterus whence it
escapes with the menstrual blood. After the escape of the
ovum  the ruptured vesicle becomes cicatrised, and forms a
yellowish  spot which Wagner terms the germinal spot.
Formerly when the physiology of the female functions was
yet little understood, it was supposed that this yellow spot
was a sign of previous fecundation; but this spot is seen in
girls who had never conceived; for a little ovum is detached
at each menstruation, and after its escape, leaves this yellow
spot.
The first menses generally make their appearance towards
the fourteenth year, and the menstrual discharge ceases again
between the forty-fifth and fiftieth year. It is a most important function in the female organism; irregularities as to
time and quantity induce a variety of disturbances.  The
menstrual blood is dark and does not readily coagulate;
during its discharge the mucous membrane of the uterus is
renovated.
Before we pass to an examination of the difficult and interesting question, how and where the semen comes in contact
with the ovum, it may not be out of place to describe the
interesting experiments of artificial fecundation of the eggs of




THE FEMAtE OVUM.                  37
frogs that have been instituted by Spallanzani, Prevost and
Dumas.  Spallanzani watched the fecundating process as
carried on by frogs in and out of the water. At the instant
when the female wants to lay her eggs, the male spirts a
clear fluid upon them, by which means fecundation takes
place.  Having covered the legs of the male with oil-silk, the
eggs remained unfecundated, and a sufficient quantity of the fluid
was found adhering to the oil-silk leggins, to enable him to collect some of it by means of a fine painter's brush. Every egg
which he touched with this fluid, became fecundated. This
experiment was repeated by Prevost and Dumas, and it was
found that this direct fecundation was always accompanied by
the presence of spermatozoa. This fact puts an end to the
formerly prevailing opinion that fecundation was effected by
a seminal aura.  Semen and ova have been placed so near to
each other, that the latter had to be touched by the seminal
exhalation; but no fecundation took place, and was, on the
other hand, effected immediately as soon as actual contact
between the seminal fluid and the ovum had taken place. If
the spermatozoa are motionless, consequently dead; or if
they are sickly, or imperfectly developed, in such a case they
are of no use as fecundating agents, and, if this should be
the condition of the human spermatozoa, the male semen is
unfit to carry on the process of fecundation, and sterility
ensues.
Let us now enquire where the process of fecundation takes
place in the human subject. Numerous experiments and investigations have recently shown that it is in the ovaries that the
semen comes in contact with the ovum and that the first germ
of the future man is formed. It is only among the inferior
animals that the eggs are detached from their original abode
previous to fecundation; among the higher species the male
semen goes to the ovum while yet lodged in the ovary.  On
this account fecundation is most readily effected shortly previous to the menstrual period; for the ovum may have escaped
from its vesicle, and is perhaps on its way to the uterine
cavity, meeting the semen half way. Starting from this sup



38                 THE FEMALE OVUM.
position it has been laid down as a rule that, in order to avoid
fecundation, no intercourse with the female should be had
eight days before, nor eight days after the menstrual period.
The supposition that the fecundating process takes place
in the ovary, is fortified by the following reasons: 1. If
animals are killed shortly after conception, semen is found
in the ovaries; 2. The eggs of birds only reach the period of
maturity gradually, and the ova of mammalia do not penetrate the uterine cavity until some time after the accomplishment of the sexual act, when the semen could no longer be
fresh and possessed-of fecundating power; 3. Pregnancy may
take place beyond the uterine cavity; 4. If shortly after the
sexual act the Fallopian tubes are tied, no fecundation takes
place.
Formerly the process of fecundation was accounted for in
a different manner. The doctrine was, that a seminal aura
penetrated through the uterine cavity and the Fallopian tubes
to the ovaries, where it effected the process of fecundation.
This being accomplished, the fecundated ovum was conveyed
into the uterine cavity for the purpose of further development.
This opinion was undoubtedly very ingenious, but erroneous.
Fecundation is only effected when both the male and female
seminal secretions meet at one and the same moment. But
this can only be accomplished when the semen is healthy,
and the penis sufficiently erect to introduce the semen into
the uterus. If the ovum is not sufficiently developed, if the
tubes are closed, if the neck of the uterus is either closed or
deviating from its normal axis, if the vagina is obstructed,
etc., fecundation is impossible.
From these facts which have been abundantly established
by modern physiologists, we infer that the procreation of a
new human  being requires as a necessary condition the
immediate contact of the semen and the ovum.
The next question is, to ascertain what part the semen and
the ovum respectively take in the act of fecundation.
To solve this question, a multitude of hypotheses have been
resorted to.  It was supposed that the semen of the male




THE FEMALE OVUM.                    39
being composed of all the constituent parts of the body, it
furnished the first elements towards the formation of the
different organs and tissues of the new being. Or it was
believed that the semen itself, together with the spermatozoa,
after undergoing a number of transformations, formed the
new man, or, at any rate, the principal portion of this new
man, namely, the nervous system.  Another opinion was,
that the semen was a living fluid, and that it excited life and
developments in a female germ, the ovum.
In regard to the product of the ovary, opinions were equally
diversified. Some said that a vesicle was filled with semen
which, like the semen of the male, consisted of the original
elements of the various constituent organs of the body; others
taught that the ovum was transformed into a receptacle for the
spermatozoa to which it furnished sustenance; some again
supposed that some unorganized substance that had the properties of gelatine, was the cause of life by exciting motion.
Finally, according to the opinion of modern physiologists,
such as Valentin, Joh. Mueller, Wagner, Bisehoff, Bracke,
etc., the ovum, after being detached from  the ovary, derives
from the semen the property of developing itself further in the
uterus, and evolving a new being endowed with life, and
resembling both the father and the mother.
If a perfect commingling of the seminal secretions takes
place, it is just as impossible for either the male or female to
prevent conception, as it is otherwise impossible to determine
the physical or moral qualities of the foetus. Some of the
ancients, physiologists and physicians, among whom we distinguish, Anaxagoras, Aristoteles, Hippocrates, fancied that
the right testicle and ovary furnished the elementary constituents of the boy, and the corresponding left organs those of
the girl.  If this were so, it must certainly be possible, during
intercourse, to cause either the left or right organs to be
principally active; but this seems impossible so far as we
know. But the opinion itself is erroneous; for we know of
men who, after losing one testicle, procreated both male and
female children; and so in regard to women: with one ovary




40                 THE FEMALE OVUM.
only, boys and girls indifferently were the result of conception. Similar results were experimentally obtained in the
case of rabbits.
It is likewise beyond the power of the male or female to
determine by volition the number of ova that are to be fecundated. In the case of man, one ovum is the rule; but there
are cases where two, three, and even four and five children
were born at one birth.
Nevertheless, the physical and moral qualities of the fetal
child are not entirely beyond the reach of the parents' influence. Such an influence is however exercised only gradually.
The condition of the foetus depends upon the moral state of the
parents during the sexual act, and upon a certain degree of
activity which is required to secure the proper performance
of the act. It is past all doubt that the vitality of the child
is more or less proportionate to the vigor and cheerfulness,
or to the indifference and unwillingness which were displayed
during coit. Excessive sexual intercourse results in the procreation of weakly children, whereas healthy and vigorous
children are the consequences of a moderate and rational
enjoyment of the sexual pleasure.  Too frequent coit, excessive sexual passion, and even premature marriage, are prejudicial to child-bearing. To secure the highest degree of
fecundity, the husband should be about ten years older than
the wife. The fecundity of the human female is greatest up
to the age of twenty-six years, that of the human male up to
thirty-three.  An active mode of life and bodily exercise
favor conception, even among those who are obliged to live
poorly, although want and starvation diminish the number of
births proportionally to the high price of food. In warm
climates and along the coast, conception takes place more
readily than in colder climates. Some nations are distinguished in this respect. The fecundity of the Jewish females
was known even to the Egyptians; negro women conceive
more readily than white women; the Slavish race is, in this
respect, superior to the Germanic nations. There are years
when the number of births is much less than in others.




THI  FEMALE OVUM.                  41
After an earthquake it was observed that for two years the
women ceased to bear children.*  After a war or an epidemic disease the number of births is generally much greater
than ordinarily.
Conception generally takes place when the  semen  is
retained after coit. However, this is not by any means a
rule.  Some women can tell immediately after the act
whether conception has taken place; others know it only
some days after by a series of peculiar sensations, such as
vertigo, nausea, vomiting, colic, aversion to certain kinds of
food and to sexual intercourse.
Conception depends upon both external and internal circumstances. The greatest number of pregnancies generally
occurs during the months of May and June. Ardent women
are said to conceive more readily in winter, colder women in
summer. Indifference or aversion to intercourse is an obstacle
to conception, although it has happened that women have
conceived during sleep, and even after rape.
* This might have been the result of fright.-ED.
4




SECTION  II.
OF THE DISEASES OF THE SEXUAL AND URINARY ORGANS.
IN the preceding section the anatomy and physiology of
the urinary and sexual organs have been explained. We
have seen that these organs perform exceedingly important
functions in the human organism, and that the urinary organs
in particular are necessary to the preservation of life and
health, for they eliminate all such constituents of the blood
as are no longer serviceable to the reproduction of the tissues, and which, if retained in the blood, would cause disease;
hence we infer that the preservation and healthful condition
of these organs are essentially necessary to the normal condition of the organism. We have likewise seen that the sexual
organs subserve the purpose of procreation, and that their high
object can only be accomplished by preserving them in health
and strength, and enabling them to perform their peculiar
process of secretion readily and without the least hindrance.
In  the following  sections we intend to describe and
explain the various disturbances to which the functions of
these organs are liable, and to indicate the remedies which
are capable of restoring them to a state of health in the
quickest, safest, pleasantest and most lasting manner. We
shall likewise point out to the reader the rules and principles
by the observance of which a derangement of their functions
may be avoided.
We shall have to examine the diseases of these organs in
a twofold point of view. Some of these diseases arise from
causes which are of a general character and have nothing to
do with syphilitic contagion; but by far the larger number
is the result of syphilitic infection which is communicated by
one sex to the other during the sexual act, and by which




HISTORY OF SYPHILIS.                  43
the highest earthly delight is not only converted into a
source of loathsome and distressing disease, but which likewise results in the procreation of an unhealthy, miserable
offspring. We will begin our work with the treatment of the
more important class, the syphilitic diseases, premising a
short indication of their probable origin and their successive
development in the different periods of the world's history.
The first historical investigations of this disease were
instituted  from religious motives.  Venereal diseases were
represented as a punishment from God for sexual transgressions.  At a later period, these investigations assumed a
political character, and served to gratify national antipathies.
The French termed the syphilitic disease " mal de Naples,"
the Italians " mal Francese," the Germans "Franzosen."
Oviedo, a Spaniard, derived the disease from  the American
Indians, as if to palliate the cruelties which had been perpetrated by his countrymen against the aborigines of America.
Science is interested in these historical investigations of
the origin and spreading of the disease; for a knowledge of
these facts may facilitate the treatment, and suggest correct
views concerning the infectious character of the malady.
Let us therefore cast a glance at its history.
The history of syphilis may be divided into three periods;
the first extends to the end of the fifteenth century, or the
epidemic of 1495; the second extends from this period to
the time when Fernel made the discovery that syphilis is a
specific poison; and the third period extends to the present
day.
It is an established fact that' the origin of the venereal
disease is lost in the remotest antiquity.  It seems superfluous to repeat in this place the various contradictory
opinions in reference to this matter. The first allusions to
venereal discharges are contained in the books of Moses. As
regards genuine syphilis, it is not by any means impossible
that this disease, like glanders and small pox, may have been
transmitted to man by the brute creation. It is well known
that many diseases are ingrafted upon the human species by




44                HISTORY OF SYPHILIS.
animals, and are afterwards developed among mankind as a
disease peculiar to them.  It is not therefore, improbable
that syphilis has a similar origin, which is somewhat confirmed by the derivation of the term syphilis from the Greek
words, sys, swine, and phileo, to love.'Besides the allusions to a contagious discharge from the
urethra, contained in the books of Moses, we find similar
allusions in the writings of the ancient Greek physicians,
from which the existence of syphilis may be inferred. Hippocrates mentions ulcers of the sexual organs, pustules of
the penis, and a considerable number of other affections
arising from the progressive development of syphilis.
Celsus describes every variety of chancre with or without
phimosis, the indurated Hunterian chancre, and the phagedenic chancre.
Galen describes a case of gonorrhoea contracted by coit.
Avicenna gave a detailed account of ulcers of the penis
which resemble perfectly the modern chancre. Michael Scott
relates cases of disease which were communicated to men by
unclean females'and vice versa, and which produced symptoms which resembled exactly the modern  constitutional
syphilis.
W. Saliceto, Lanfranc and their disciples describe ichorous,
virulent or so-called acrid discharges inducing a variety of
affections of the sexual organs and genuine buboes. A detailed
account of syphilis is also found in the work of W. Becket
who communicates the rules laid down for the prostitutes of
the city of Winchester, according to which every diseased
woman, if caught in the exercise of her trade, was fined one
hundred shillings.  These facts go to show  that ancient
authors were as well acquainted with syphilis as with the
other maladies which they describe; only they did not know
that the syphilitic disease was derived from a specific poison.
They were unacquainted with the mode in which the poison
was communicated, and they were particularly unacquainted
with the constitutional consequences of primary syphilis.
With the elder physicians constitutional syphilis was a form




HISTORY OF SYPHILIS.                45
of lepra.  Syphilis existed in the earliest ages, but its character was not yet known.
In 1494 the epidemic broke out.  Some twenty different
nations were invaded by it.  In Germany the disease had
been unknown previous to this time.  The morals of the
people were rigid, and prostitution was rare.  Morever, there
was little intercourse between the different German states.
This was different in other countries, especially in Italy:
a wide-spread commerce on the sea, luxurious living, shameless immorality, and the celibacy of the priests naturally
spread the disease far and wide.
The campaign of Charles VIII. of France was one of
the chief causes of the spread of the epidemic; hence its
name morbus gallicus, or French disease.  In the month of
August, 1494, Charles invaded Italy with a well appointed
army, for the purpose of chastising Pope Alexander VI. who
was opposed to his pretensions, and of conquering the kingdom of Naples, which had fallen to him as an inheritance.
The soldiers carried off an immense booty, but at the same
time the syphilitic disease.  They termed it souvenir or mal
de Naples, in which city it had existed previous to the arrival
of the French, and where it exercised the greatest ravages
among them.  The assertion that the disease was brought by
the Spaniards from America, is without any foundation; for
it was first in 1495 that a Spanish army was sent to Italy,
consequently one year after the character of the disease had
already been established.
In Germany the spread of thle disease was principally
attributed to the lansquenets, a military rabble, who were
constantly ready to sell their life and blood to the highest
bidder. With what frightful rapidity syphilis spread in an
army, was sufficiently demonstrated in the last wars. It was
not to be wondered that syphilis should have spread throughout Europe in the fifteenth century, when the whole continent was traversed by military hosts; nor that physicians
should have begun to suspect the connection between primary
and secondary syphilis. One reason why this knowledge was




46                HISTORY OF SYPHILIS.
so tardily obtained, was the fact that physicians were ashamed
of treating ulcers of the sexual organs, and left this dirty
business to quacks of every description.
The same confusion which prevailed as respects the origin
of syphilis, likewise prevailed in regard to the mode in which
the disease was transmitted. It was believed that the disease
might be transmitted by the atmosphere, and that it might
be introduced into and carried out of a convent through the
lattice-door in the parlor.  Fallopius fancied that the disease might be communicated by the holy water into which a
syphilitic patient had dipped his finger. Only an obscure
idea was had of the syphilitic poison.
It was not until the year 1556 that Fernel showed that the
syphilitic disease originated in some specific cause emanating
from some affected individual, and acting upon one in health.
He deserves the credit of having opposed the opinion that
the disease was communicated by the atmosphere. Forsaking
the belief in astrological, cosmic or teleological ideas, which
prevailed in his time, he succeeded in describing with great
correctness the mode of transmission of the syphilitic disease.
He teaches that it is contagious, and that contagion is indispensable to its transmission.  Contagion cannot take place
without actual contact, and the most frequent contact is
during sexual intercourse.  With a master's hand Fernel
describes the symptoms by which the contagion is recognised,
likewise the secondary or constitutional symptoms. Even
after a lapse of three hundred years, Fernel's picture of the
syphilitic disease is still true, and the recent additions have
only served to make it appear still more so.
Fernel's' doctrines were perfected and confirmed by John
Hunter and Carmichael, but the most scientific works on
syphilis, in which the disease is discussed with all the light
which modern science has shed upon every form of knowledge,
emanate from the pen of Ricord of Paris, Simon of Hamburg,
Sigmund of Vienna, Waller of Prague, etc.




GONORRHCEA.                     47
First Series of Syphilitic Diseases.
It is peculiar to these diseases to arise either directly or
indirectly from  an impure coit, and to be transmitted to
other persons by some specific contagion, somewhat in'a
similar manner to the inoculation of the small-pox. Hence it
is that these diseases first break out on the sexual organs,
and, by means of the lymphatic system, are thence carried
thropgh the whole organism.  Generally the chancre either
breaks out on the integuments of the penis, where the skin
had been excoriated, or in some part where the delicate
epidermis had been injured, as on the glans penis, on the
mucous membrane of the pudendum, on the labia, etc.
We will distinguish this larger group of diseases into two
divisions, 1st, simple venereal diseases, and 2d, venereal or
syphilitic diseases properly speaking.
I.  SIMPLE VENEREAL DISEASES.
These are diseases which have not the specific syphilitic
character, and do not induce constitutional syphilis by penetrating the general organism.  Among these diseases we
number gonorrhoea and blennorrhoea, together with all the
accessory and secondary affections belonging to these discharges, female gonorrhoea and common leucorrhoea.
II.  GONORRHIEA OF THE MALE.
By gonorrhoea we understand a violent inflammation of the
mucous membrane of the urethra, with a discharge of purulent mucus.
The course of this disease is generally as follows:-From
two to five days after an impure coit, the patients generally
experience a peculiar itching at the tip of the penis, which,
during an erection, increases to a real pain. This pain is
aggravated during an emission of urine.  In two or three
days more, the orifice of the urethra becomes red, swollen
and moist.  Frequently a tension and drawing are expe



48                     GONORRH(EA.
rienced at this period in the spermatic cord, the testes, the
inguinal region. After urinating, a slight burning pain is
experienced, which increases from day to day.  The swelling
and redness of the urethra likewise increases, and a discharge, which is at first inconsiderable and is generally clear
and viscid, takes place from the urethra, and causes the sides
of the orifice to adhere. The linen looks stained, the glans
swells more or less, becomes hot, red, and is painful during
a walk. The erections are distressing, and are particularly
frequent at night, disturbing sleep.  On the eighth day, and
sometimes earlier, the discharge increases, becomes thicker,
of a yellowish-white color, milky. The inflammatory symptoms gradually increase in violence and extent. The pain
during urination and during erections, reaches the highest
degree of violence, and is no longer confined to the forepart
of the penis, but extends over the whole organ. On account
of the inflammation, the urethra becomes contracted; hence
the stream of urine is no longer full and large, but divided.
The discharge assumes a greenish-yellow tint, becomes thick,
profuse, and has a peculiar, disagreeable odor. When sitting
the patient experiences pain, and the perinaeum even is sometimes swollen in consequence of the inflammation of Cowper's
glands.
This second stage of gonorrhoea generally commences on
the seventh or eighth day, and continues for eight days or
a fortnight. It is of great importance in the treatment of
the disease, that the first and second stages should not be
confounded.
In the stage of decrease the first sign of improvement is,
that the emission of urine and the erections are less painful,
and finally become altogether painless; only the discharge
continues, and changes to a whitish, viscid, thready secretion.
The redness at the orifice of the urethra, and the swelling of
the glans disappear.  If these symptoms should continue
for awhile, without being accompanied by pain, we term them
secondary gonorrhoea or gleet.
Whatever cause is capable of inducing an inflammation of




GONORRH(EA.                      49
the urethra, may likewise cause a gonorrhoeal discharge. This
need not necessarily be the result of an impure colt. New
wine, unfermented beer; stimulating spices, a cold, exposure
of the organs to the wind while urinating, frequently dause a
gonorrhceal discharge which runs the same course as, and is
similar to, genuine gonorrhoea.
As regards the disposition to gonorrhoea, it generally
occurs among young people.  Persons with a long and
narrow prepuce are more easily infected than those whose
prepuce glides loosely over the glans, or in whom the glans
is not at all covered by this organ. In such cases the glans
is much less sensitive, and hence less liable to the action of
the gonorrhceal poison.  Among the nations where circumcision is practised, gonorrhoea is much less frequent than
among us.
A  gonorrhoeal discharge  may likewise be induced by
mechanical or ohemical causes, by a natural predisposition,
climate, a peculiar structure of the sexual organs, and by
constitutional debility.
Among the mechanical causes of gonorrhoea, we may mention the introduction of the catheter or of a bougie into the
urethra, mechanical injuries of the mucous membrane of this
canal, calculi or other foreign bodies in the urethra, etc.
Among the chemical causes we note injections of irritating
substances, abuse of spirits, spices, salt food, asparagus and
beer.
As regards predisposition, persons of a plethoric habit, with
blond hair, a fine white color, and a delicate frame, are more
easily tainted than those who do not possess these qualities.
In regard to climate, it may be stated, that gonorrhoea
occurs more frequently in a warm than in a cold climate.
So far as the structure of the organs is concerned, a large
penis, a wide urethra lined with a thick mucous membrane,
repeated infections, strictures, or disorganizations of the
mucous tissue, facilitate the gonorrhoeal contagion.
The forms of constitutional irritation which predispose one
more particularly to- gonorrhoea, are cutaneous eruptions,




50                    GONORRHOEA.
scrofula, tubercles, gout, rheumatism  and piles.  Onanism
and venereal excesses may likewise cause a discharge from
the urethra without any other infectious contact.
The most frequent cause of gonorrhoea is an impure coit.
Even if the coit was not completed, and the penis was simply
brought in contact with a diseased pudendum, infection may
take place. It must not be imagined, however, that a specific
or so termed virulent discharge is indispensable to effect this
result. A gonorrhoeal discharge may be induced by excessive
sexual intercourse, even among married persons, by an imperfectly executed or an excessively prolonged coit; by having
intercourse during the menstrual period, or during the last
months of pregnancy, when the ordinary vaginal discharge
becomes quite considerable, and sometimes very acrid, or by
ulceration of the neck of the womb.
It is a remarkable fact, that some men can have sexual
intercourse with women who have the whites, without being
affected by this discharge, whereas other men are at once
infected by these same persons. This must be owing to the
fact, that some men are not susceptible to this kind of infection, whereas others are so to an extraordinary degree. I
have known cases, and other authors have had a similar experience, that several men in succession had intercourse with
the same girl, and that some of them were infected, others,
on the contrary, remained intact. There are likewise cases
where a gonorrhoeal discharge took place without the least
symptom of discharge or ulceration being perceptible in the
girl, even after the strictest examination by a physician.
It may likewise happen that women had been infected by a
man, and that previous to any discharge having yet made its
appearance, they communicated the disease to the next customer.
A gonorrhoea which had developed itself after intercourse
with a perfectly healthy woman, is frequently more obstinate,
and more unyielding to treatment than a genuine syphilitic
dischaige. It is therefore necessary to be acquainted with




GONORRHOEA.                     51
the rules, byk the observance of which a gonorrhoeal ihfection
can be prevented.
To this end every unnatural excitement should be avoided,
before and during an embrace.  Stimulation by means of
spices or spirits, unnatural means of producing sexual excitement during the act, excessive enjoyment of the sexual
pleasure, etc., are sometimes sufficient to excite a gonorrhoeal
discharge.
It is an established fact that the preservation of a man's
health, especially in the full vigor of manhood, requires the
enjoyment of sexual intercourse.  Complete abstinence from
all intercourse is sometimes followed by dangerous diseases,
especially in healthy and vigorous men. Considering that
there are many men in large cities, who do not get married because they either have not the means of supporting a
family, or because they do not find any one whom they desire
to marry, prostitutes seem to be a necessary evil for the time
being.  The following rules should be observed during sexual
intercourse with a prostitute: the act should be accomplished
in as short a time as possible, and, immediately after the ejaculation of the semen, the penis should be withdrawn, because
it is a well-known fact that the susceptibility of the organ to
the reception of the contagion is much increased.
After the coit the penis should at once be washed with a
solution of soap, and the urine should be voided, because by
this means the morbid matter which might have adhered to
the parts, would again be easily expelled.
Some grease the penis with a fatty substance previous to
its introduction into the vagina; by this means the pores of
the skin are obstructed, and the poison is prevented from
penetrating into the parts.  The safest preventive is undoubtedly the condom or guards.
Any other preventives, many of which have been announced with a great flourish, are either useless or even
injurious. Injections are particularly to be avoided; they
simply serve to carry the gonorrhoeal matter which may have
been left in the urethra, still farther along in this canal. By




52                     GONORRHEA.
observing the rules which we have indicated, infection will
be prevented in most cases.
The treatment of gonorrhcea embraces, 1, a regulation of
the mode of life, and 2, the therapeutic treatment. A suitable regime is indispensable to a cure.  If gonorrhoeal patients could be kept at home, in a horizontal position, upon a
horse-hair mattrass, chronic gonorrhoea would become a very
rare disease.
Let the patient, therefore, remain as quiet as possible; let
him  avoid all violent exercise, such as dancing, riding on
horseback, and likewise every kind of excitement, especially
of a sexual nature. The food and beverages he uses, should
be without any irritating influence, especially as long as
symptoms of inflammation remain visible.  He should eat
little, and what little he does eat, should be easily digestible.
Stool should be had every day.  Cleanliness is indispensable
to a successful cure.  The linen and the rags which are tied
round the parts, should be changed frequently; the penis and
the organs generally should be carefully cleansed with tepid
or cold water, and the adhering matter washed off. In washing the parts, all violent friction should be strictly avoided.
If the linen should adhere to the orifice of the urethra, it
should never be torn off by force, but should first be loosened
by soaking it with warm water. If the lips of the orifice should
be glued together, and the patient should wish to void urine,
care must be had first to free the orifice by moistening it
with saliva; otherwise the forcible passage,of the stream
through the orifice might cause irritation, pain, and even a
little hoemorrhage from ruptured capillaries.
In case of inflammatory irritation, tepid local and general
baths are to be used, both for purposes of cleanliness, and in
order to alleviate the pain and inflammation. But cold baths
should be resorted to as soon as the inflammatory symptoms
have been subdued, or even from  the commencement, if no
inflammatory symptoms should at all be present. Water may
be drank in quantity, for the purpose of securing a less painful emission of urine, and diminishing the naturally irritating




GONORRHCEA.                      53
properties of this fluid. Patients who are obliged to be about
on account of business, will do well to wear a suspensory.
Let us now speak of the medical treatment of this disease.
In gonorrhoea, as well as in any other disease, the homoeopathic treatment has decided advantages over the allopathic.
However, it is not my intention to mention the large number
of remedies which have been recommended by homoeopathic
physicians, many of them with extravagant praise. I shall
simply mention such remedies as have proved efficient in the
many cases that I have been called upon to treat. They are
the following, together with the symptomatic indications.
Agnus castus is particularly adapted to a yellow purulent
discharge from the urethra, after the inflammatory symptoms
have subsided for the most part, and in cases of gleet, accompanied by want of erections and deficient sexual desire.
Argentum nitricum is useful when the emission of urine is
accompanied by burning, and if a sensation is experienced as
though the urethra were closed, and the last portion of the
urine remained behind in the urethra; it is also indicated by
dragging pains in the urethra, cutting along the urethra as
far as the anus, feeling of soreness in the urethra even after
micturition, haemorrhage from the urethra, painful tensive
erections, discharge of mucus from the urethra.
Balsamum copaiv. is indicated by smarting pain, burning
and itching in the urethra before and after micturition, swelling and inflammation of the orifice of the urethra, painful
soreness of the urethra, and purulent discharge from  the
same.
Cannabis: Smarting pain in the urethra between the acts
of micturition, constant urging to urinate, burning and stinging in the urethra, at the corona glandis, and in the outer
parts of the prepuce, erections with tensive pains, titillation
in the urethra, glueing together of the orifice of the urethra
by a moisture which becomes visible on compressing the glans.
Cantharides: Cutting in the urethra during and after micturition; yellowish discharge, which leaves a yellow stain on
the linen, and increase of the discharge in secondary gonor



5,4                    GONORRHCEA.
rhoea; this agent frequently cuts short the disease when
given as soon as the first signs of inflammation become apparent,
Capsicum: Burning at the orifice of the urethra before,
during and after micturition, painfulness of the urethra to
contact, cutting pain in the urethra between the acts of micturition, pricking as with pins in the forepart of the urethra,
thick, purulent, yellow discharge.
Cocculus: Tensive, aching pain in the orifice of the urethra,
between the acts of micturition, itching stinging in the forepart of the urethra.'Ferrum: Discharge of mucus from  the urethra after a
cold.
Mercurius solubilis: Burning pain of the urethra when
touching the penis, inflammation of the orifice of the urethra,
swelling of the forepart of the urethra with suppuration
between the glans and prepuce, redness and heat of the
urethra, with painfulness of the same when touching it or
when walking, accompanied by a raging pain in the forehead,
a feeble stream of the urine, itching and stinging in the forepart of the urethra, throbbing in the same, and a greenish,
painless discharge, especially at night, or a slight secretion
of moisture from the forepart of the urethra.
Mezereum: Stinging, titillating pain at the urethra and
discharge of a little moisture; tearing and drawing through
the whole of the urethra, commencing at the perinaeum;
painful soreness of the urethra when touching it, or partly
before, and partly during micturition, and discharge of a
watery mucus from the urethra during exercise.
Nux vomica: Pressive pain at the orifice of the urethra
between the acts of micturition, accompanied by a feeling of
shuddering; sharp pressure, as with a cutting or sticking
instrument in the forepart of the -urethra, at the bladder,
neck of the bladder, perinmeum, rectum, anus, as if cutting
flatulence were endeavoring to issue from  all these parts;
accompanied by contractive pains in the forepart of the
urethra between the acts of micturition, and discharge of




GONORRHOEA.                      55
mucus from the urethra depending upon haemorrhoidal affections.
Petroselinum: Tingling and pressure in the urethra in the
region of Cowper's glands, especially early in the morning in
bed, abating when standing or sitting; drawing and pressure
in the navicular fossa, secretion of a milky fluid from the
urethra which can be pressed out; glueing together of the
urethra by mucus, discharge of a yellow, glutinous matter
from the urethra.
Pulsatilla: Contraction of the urethra and thin stream of
the urine, discharge of blood from the urethra, swelling of
the testes and inflammation of the eyes caused by suppression of gonorrhoea.
Mercurius corrosivus: Inflammation of the meatus urinarius,.itching in the front part of the urethra, smarting pain
during micturition, and stitches to and fro in the urethra.,
with a discharge which is at first thin, afterwards thickly.
Sulphur: Burning in the forepart of the urethra, internally and externally, pains in the urethra at the commencement of gonorrhoea, redness and inflammation of the meatus
urinarius, thin stream of the urine, itching in the middle
of the urethra, constant desire to urinate, tearing and stinging in the urethra between the acts of micturition, cutting in the urethra before and during stool, and stitches in
the forepart of the urethra.
Thuja: Burning in the urethra; burning, piercing stitches
near the orifice of the urethra between the acts of micturition, sensation in the urethra as if a drop would run out of
it, drawing, cutting pain in the urethra especially when walking, stitches in the urethra from behind forwards between the
acts of micturition, jerking pain in the urethra, and a watery,
copious discharge.
[Dose.-During the acute or inflammatory stage, the tincttures or lower attenuations or lower triturations may be
administered, one grain three times a day, or one-third of a
drop three times a day, in a spoonful of water or on a little
sugar; after the inflammatory symptoms have been subdued,




56                   BALANNORRHCEA.
or in the gleetish form of the disease, the middle and higher
attenuations may be resorted to, one drop morning and night,
and, if a decided improvement is perceived, only one dose
every night before retiring. This remark applies to all the
remedies and diseases mentioned in this section of the work,
as far as SYPHILITIC DISEASES PROPER.]
Balannorrheea, balanitis, balanoposthitis.
By balanorrhoea we understand an inflammation and a
purulent secretion on the surface of the glans and on the
inner side of the prepuce, a condition which may arise from
gonorrhoeal infection as well as from the action of non-contagious irritating causes.
This secretion emanates from the follicular glands situated
behind the corona glandis and which, even in health, secrete
a cheesy, strong-smelling substance.
The disease generally runs the following course: at first
the patients experience a slight smarting or burning on the
surface of the glans or in the prepuce. The parts, especially
the glans, are hot, of a rose color or a bright carmine redness, somewhat swollen, sensitive to pressure and especially
to the rubbing of the clothes when walking. The follicular
secretion is very much increased; it soon becomes purulent,
thick, greenish-yellow. The pus is discharged on each side
of the fraenulum in large tenacious drops. The margin of
the prepuce is swollen, bright red, somewhat distended; both
it and the folds of the prepuce are constantly filled with pus
which sometimes dries up, forming small' crusts of a dirty
yellow color, and causing the prepuce to adhere to the linen.
The inner surface of the prepuce has an intensely bright-red
color.  Upon this inner surface as well as upon the glans,
we soon notice erosions of the mucous membrane having a
red or grayish-red color, and readily becoming gangrenous
and inducing violent incidental affections, such as phymosis,
paraphymosis, which will be described bye and bye.  The
flat little ulcers are not syphilitic, and are caused by the
acridity of the secreted matter. In most cases they remain




BALANNO.RRH(EA.                   57
unchanged for a week or a fortnight, after which the cure is
rapidly effected.
A benign balannorrhoea frequently occurs in children, but
principally in individuals with a long prepuce which is not
entirely drawn behind the glans during coit, on which
account the pus which has penetrated between it and the
glans is enabled to remain without being disturbed. However, balannorrhoea may likewise occur when the prepuce is
short or even entirely wanting. Circumcised persons are
free from it almost entirely. This secretion is not contagious.
The venereal or contagious balannorrhoea is contracted
during coit. It is of rare occurrence, notwithstanding that
the surface of the'glans is sooner exposed to the contagious
pus than the urethra.
This circumstance may be owing to the peculiar nature of
the epithelium of the glans, and to the fact that the pus
adheres to it but a short time, and is then wiped off again.
It generally shows itself sooner than gonorrhoea, sometimes
one or two hours, but in most cases from  three to six days
after an impure coit.
In regard to preventive means, the same rules should be
followed that we have laid down in treating of gonorrhoea;
cleanliness, washing the parts with soap and water after
intercourse, and  all the other precautionary  rules are
indispensable.
In regard to regime and diet, the same rules have to be
followed that have been mentioned for gonorrhoea.
Of the remedies used the following were found the most
efficient: Aciduzm  HYitricum, Cannabis, Capsicum, China,
Cinnabaris, Mercurius solubilis,'Mezereumn, Nux vomica,
Pulsatilla, Sabina, Stannum, Sulphur, and Thuja.  The
following are the symptomatic indications:
Acidum Nitricum: Balannorrhoea with small vesicles in the
orifice of the uretha, on the inner surface, and at the margin
of the prepuce; they soon break, suppurate, and form chancrous ulcers; or with brown, painful, lentil-sized spots on
5




58                   BALANNORRHEA.
the glans, excavated ulcers on the glans, with elevated, leadcolored, sensitive margins; flat, clean little ulcers at the
corona glandis, secreting a strong-smelling matter; fleshcolored excrescences at the corona glandis, secreting a fetid
humor and bleeding when touched; itching of the prepuce,
and humid spots on its inner surface, and sharp stinging
pains in the same.
Cannabis: The glans is covered with small bright-red
spots, which are lighter than the glans itself when the glans
is as red as the prepuce; redness and dampness behind the
corona glandis; itching under the prepuce, and  at the
frsenulum; swelling of the glans and penis, like a sort of
painless erection; dampness round the corona glandis; constant burning of the prepuce and glans.
Capsicum: Constant pressure and prickling in the glans;
fine itching, stinging of the glans as if bit by mosquitoes.
China: Burning in the glans, and creeping and pressure in
the urethra and anus; itching of the glans, especially in the
evening in bed; twitching pain between the glans and prepuce during a walk; tearing pain in the left side of the
prepuce, and in the left testicle; fine pricking at the franulum as with pins.'Cinnabaris: Burning, stinging, itching  of the corona
glandis; itching pain in the fossa behind the glans, with
exudation of pus of a nauseous sweetish smell; tearing
stitches in the glans; small red spots on the glans; or red
shining.little dots or readily-bleeding warts on the prepuce.
Mercurius solubilis: Burning around the glans, followed
by the breaking out of vesicles on the inner surface of the
prepuce, which soon break and give rise to small ulcers, with
itching stinging in the glans after pressure; tearing stitching
pain in the fore-part of the glans, extending through the
whole penis as far as behind the anus, and sometimes even
as far as the groins; vesicles on the fore-part of the glans, on
the upper surface, and at the sides, penetrating and spreading,
and discharging an acrid humor; suppuration between the
glans and prepuce, with swelling of the fore-part of the




BALANNORRHCEA.                    59
urethra, which looks red and feels hot, and is very painful
when touched or during exercise; ulcers on the glans and
prepuce,' with a cheesy, lardaceous bottom, and a hard
margin; swelling of the glans and prepuce; tingling at the
fraenulum and scrotum; fine red eruption on the outer, and
cracks and rhagades on the inner surface of the swollen
prepuce.
Mezereum: Itching, tearing and Switching tearing in the
glans;' fine prickling stitches in the penis and at the tip of
the glans; tearing drawing at the corona glandis, with secretion of a quantity of yellowish smegma in that region, and
inflammatory redness of the prepuce which exhibits excoriations, accompanied by a feeling of soreness in the glans and
prepuce.
Nux vomica: Smarting and burning itching of the glans,
copious secretion of smegma behind the corona glandis;
smarting itching of the inner side of the prepuce, especially
towards evening.
Pulsatilla: Smarting and corrosive itching of the glans
under the prepuce; agreeable titillation of the glans, accompanied by a discharge of a colorless mucus; constrictive pain
behind the glans; itching, smarting pain of the inner and
upper portion of the prepuce; finely stinging itching in the
prepuce when sitting or lying.
Sabina: Burning soreness of the glans when touching it;
dark redness of the glans; painfulness of the prepuce, and
inability to press it back behind the glans; occasional turns
of pain at the fraenulum.
Stannum: Burning pain in the glans, followed by urging
to urinate; burning prickings in the glans.
Sulphur: Swelling, redness and coldness of the prepuce
and glans, accompanied by stitches in the penis.
Thuja: Burning itching, with a feeling of soreness and
stitches in the glans; titillating sensation between the prepuce and glans; violent stitches in the glans near the urethra,
which are always accompanied by an urging to urinate, the
urine passing off in drops, the stitches are at times very




60        ERECTIONS.-SATYRIASIS AND PRIAPISM.
violent, and at other times they disappear altogether; red
spots and erosions on the corona glandis, which become moist
and suppurate; flat, unclean, red ulcers, with burning pain at
the corona glandis; dampness of the glans, with acutely-painful stitches in the interior of the prepuce, and smooth, red
excrescences in the region where the prepuce adheres to the
body of the penis.
Affections which accompany Gonorrhoea and Blennorrhoea.
These accessory affections are in direct relation with the
gonorrhoeal discharge.  They are either caused by it, or
supervene by chance.  We will mention these accessory
affections seriatim, give a brief description of their phenomena, and indicate  the  remedies by which they are
removed.
I. ERECTIONS.
These are present in almost every case of gonorrhoea, and
frequently cause the most violent pains. They always aggravate the inflammatory condition.  They are more painful
during a first attack of gonorrhoea than in those who had
been several times attacked with this disease.
The patient should not only observe the rules which have
been laid down for the cure of gonorrhoea, but he'should
guard against every mental or bodily excitement, and more
particularly against lascivious fancies.  He should never feel
of his parts; eat very little supper or none at all; sleep on
a horse-hair mattrass; not lie on his back; void the urine
frequently, even at night, in ordbr to avoid every possible
pressure and irritation of the seminal vesicles.
The principal remedies will be found to be Capsicum and
Cantharides, or one of the remedies mentioned for gonorrhoea, to be selected in accordance with the symptoms.
II. SATYRIASIS AND PRIAPISM.
Satyriasis (or a frantic desire for coit in the male) and
priapism, (or a painful erection of the penis,) are conditions




CHORDEE.- HEMORRHAGE FROM THE URETHRA.   61
of the parts where the erections never cease, and are accompanied by an excessive degree of sexual excitement. For
such conditions we recommend cold hip-baths, cold water
bandages round the parts, and the internal use of Agar'icus,
Petroselinum, Cantharides, Acidum  phosphoricum, Opium
and Hyoscyamus.
III. CHORDEE.
On account of the violent inflammation, the longitudinal
muscles of the urethra and the erector muscles are not put
upon the stretch simultaneously. The patients complain of
a sensation as though the penis were curved by force. This
curvature or twisting actually takes place; sometimes the
penis is bent downwards, sometimes upwards, and at other
times laterally.  These phenomena of an intensely-developed
inflammation may extend even to the corpus spongiosum. If
this inflammation is not subdued in season, it may terminate
in some chronic disorganisation, thickening, indurations and
adhesions.  If adhesions have taken place, a cure can no
longer be expected. The chordee then remains a permanent
condition of the parts, coit is more or less painful, and sometimes even impossible.
Among the lower classes, the custom still prevails here and
there to beat the penis; in order to remove the chordee; they
place the concave side upon a table, and strike the convex portion with their fist; it need scarcely be told, that this violent
proceeding sometimes results in distressing consequences.
Suitable means for the cure of this affection are cold baths
and hip-baths, vapor-baths, the use of the north-pole of the
magnet, the internal use of Capsicum, Cantharides, Chamomilla and Pulsatilla.
IV. HEMORRHAGE FROM THE URETHRA.
In very violent inflammations, a discharge of blood may be
useful, for it has been observed, that the inflammatory symptoms abated afterwards, and that even the chordee ceased.
Excessive haemorrhage is undoubtedly hurtful, and should be




62               PROSTATITIS.-DYSURIA.
arrested. The patient should be kept in a horizontal posture,
the penis should be compressed; cold water or ice should be
applied to the penis, and internally the following remedies
should be resorted to: Acidum nitricum, Argentum nitricum, Cantharides. [I have found Aconite useful in many
cases, ED.]
V. INFLAMMATION OF COWPER'S GLANDS.
This is indicated by a pain and swelling of the perinaeum.
It should be subdued as soon as possible, for it is apt to terminate in inflammation.  If the suppuration has already set
in, it must be promoted, and means afforded for the pus
to escape, lest an urinary fistula should develope itself.
As soon as the first signs of inflammation make their
appearance, we should administer iMercurius solubilis, Sulphur or Thuja.
VI. PROSTATITIS, INFLAMMATION OF THE PROSTATE GLAND.
This inflammation commences with a sensation of pressure
and heat in the perinaeum, towards the neck of the bladder
and rectum. The patients complain of a continual and painful urging to pass urine and stool; likewise of a sensation as
if some foreign body had lodged in the rectum. The pain
increases with every attempt to satisfy the urging, which is
either fruitless or results in a very scanty discharge. This
inflammation very frequently runs a chronic course.
In acute cases the following remedies are indicated: Aconite, Belladonna, Bryonia, Cannabis, MJercurius solubilis,
Phosphorus, Thuja; they have to be selected in accordance
with the symptoms.
VII. DYSURIA.
This is invariably present in every case of gonorrhoea,
where the posterior portions of the urethra are affected. We
give, according to the symptoms, Cantharides, (Yopaiva, Mercurius solubilis, Thuja.
If the urinary tenesmus should continue and a dangerous




PRURITUS.-ECZEMA.                   63
result should have to be apprehended, the catheter may have
to be introduced. The operation should be performed with
great caution, lest a false passage should be made.
Affections which may occur without Gonorrhoea.
There is a class of affections which sometimes accompany
the gonorrhoeal discharge, but may likewise occur in connection with, or without any other morbid conditions. These are
I. PRURITUS GLANDIS, ITCHING OF THE GLANS.
Sometimes the patients complain of an intolerable itching
of the glans which induces such a violent scratching that the
itching parts and those which surround them, are frequently
rendered sore by the scratching. This itching consists in an
increased irritability of the parts, is sometimes extremely
obstinate, and is apt to recur. It not only. occurs during and
after the existence of gonorrhoea, but also in cases where
neither gonorrhoea nor ulcers had existed, and where the parts
had indeed never been affected by any disease.
I have employed with the greatest success, Antimonium
crudum, Causticum, Arsenic, Oalcarea sulph.
The itching may likewise be experienced by females who
have the whites or even by such as are perfectly healthy, or
even by girls of the most unexceptionable conduct during or
after the menses. The same remedies which have been mentioned previously, will help in the case of females.
II. ECZEMA, HERPES PR2PUTIALIS.
This troublesome vesicular eruption may affect both sexes
either with or without a syphilitic taint. In the male these
vesicles are located on the prepuce and glans, in the female
on the labia majora and minora.  The inexperienced physician might easily mistake them for incipient chancre.  It is
therefore of the greatest importance to be well acquainted
with them.  Sometimes the prepuce looks red in one or more
places, the redness extending over a larger or smaller space.
Generally the patients are not aware of the disease until




64            (EDEMA PRZEPUTII.-PHYMOSIS.
their attention is directed to it by the itching of the red and
swollen parts. The fully developed vesicles are of the size of
a pin's head, never larger.
Generally several of these vesicles are clustered together,
sometimes they run into each other.  By using one or the
other of the following remedies, which have to be selected
with reference to the totality of the perceptible symptoms,
these vesicles generally dry up and disappear after the lapse
of from four to five days, after which, the itching ceases:
Acidum phosphoricum, Petroleum, Thuja.  If these vesicles
break out previous to the monthly period, we may add: Veratrum, at other times Mercurius sol.
III. (EDEMA PRAPUTII, SWELLING OF THE PREPUCE.
Gonorrhoea is sometimes accompanied by a swelling of the
prepuce caused by infiltration and exudation of a serous fluid.
If this swelling is opened, a clear, and sometimes a bloody
serum is discharged, frequently in large quantity. The prepuce looks dark-red, hot, inflamed, and the swelling is sometimes so considerable that it looks like a bladder distended by
air or water. In the former case, Cannabis and Sulpur are
the remedies, in the latter Mere. sol.
IV. PHYMOSIS.
This affection is closely related to the last-named condition,
and is frequently caused by it. It is a contraction or constriction of the prepuce in front of the glans, so that it is
either impossible or extremely difficult to pull the prepuce
over the glans. It arises from an inflammation of the subcutaneous cellular tissue of the prepuce, in which a quantity
of serum  is deposited.  The external layer of the prepuce
has the usual color, is smooth, shining; the internal mucous
membrane is of a rose color, transparent, the prepuce is considerably swollen, and the glans is likewise enlarged. These
circumstances sufficiently account for the impossibility of
denuding the glans.
Phymosis never takes place without balannorrheea; out of




PARAPHYMOSIS.                     65
eyery ten cases of balannorrhoea, one is generally accompanied by phymosis. Generally only such men are affected
by this disease as are troubled with a long and narrow prepuce even during health. Among circumcised persons this
disease is impossible.
Sometimes the swelling and inflammation of the prepuce
increase so rapidly that gangrene may set in. The prepuce
forms a large, long, dark brown-red bulbous swelling at the
extremity of the penis; its borders are enlarged like thick
lips, cracked and so narrow that only a small portion of the
secreted pus, which is generally thin, and sometimes thick,
and of a green-yellow color, can flow' out; the remainder of
the pus collects behind the corona glandis, where it forms an
indistinctly fluctuating swelling.
The pain is very acute. In some cases the remaining portion of the integuments of the penis, as far as the root, and
even the skin of the scrotum and of the inguinal region, are
involved in the inflammation.
Among the homceopathic remedies with which this affection
should be treated, we distinguish: Mere. sol., _Rhus t. Thuja,
Cannabis, Cinnabaris, Sulphur and Viola tri-color. If these
remedies should not effect a cure, it may be necessary to
make slight incisions into the prepuce, for the purpose of
allowing the fluid to escape; in extremely difficult cases,
when gangrene threatens, it may be necessary to remove the
long and unyielding prepuce with the knife.
V. PARAPHYMOSIS.
In this affection the constriction of the prepuce takes place
behind the glans.  The prepuce is generally inverted, and
the outer skin is more or less covered by the inner membrane.
If the constriction is not speedily removed, the inflammation
soon reaches a dangerous height, and invades the whole
penis.
We treat this disease with Cannabis, Sabina, Mercurius
sol., and, in dangerous cases, we may have to resort to the
operation.




66                GONORRH(AL BUBOES.
Sequelm of Gonorrhoea.
Beside the accessory or secondary affections of gonorrhoea,
of which we have treated in the preceding chapters, we have
a series of affections which are the sequelse of gonorrhoea, to
which they owe, more or less, their origin.
The sequelse of gonorrhoea may be divided into two classes,
those which arise from a metastasis of gonorrhoeal inflammation to other organs, and secondly, those which are characterised by disorganizations or functional derangements of the
organs that are sympathetically affected during the course of
gonorrhoea.
Affections caused by a Metastasis of the Gonorrhoeal Inflammation of other Organs.
I.  GLANDULAR SWELLINGS IN THE GROIN, GONORRHI(EAL
BUBOES.
These swellings occur in many cases of gonorrhoea.  In
most cases of violent gonorrhoea the inguinal glands are more
or less sensitive, even if not much swollen or inflamed. At
first they constitute moveable little tumors of the size of
beans, rather hard, painful when walking. At this stage it
is still possible to scatter them by treatment. By neglect
they become inflamed, grow larger, and then form the buboes
properly speaking.
These buboes may either be the result of con-sensual or
sympathetic irritation, or they may be an indication of genuine syphilis.  These two forms of bubo require to be distinguished with great care. We will here describe the former
variety; the second form will be treated of in the chapters
on primary syphilis.
In the case of a gonorrhoeal bubo, the cellular tissue which
surrounds the gland, first begins to swell. Gradually this
swelling increases, suppuration sets in, the skin becomes red,
the patients experience a drawing and tension in the inguinal
region, pressure on the tumor causes pain, walking becomes




GONORRHCEAL BUBOES.                 67
more troublesome; finally the swelling grows softer, the skin
over the swelling breaks, and a thick yellow pus, or a thin,
yellowish fluid is discharged, with disks of pus floating in it.
These glandular swellings supervene in the first fortnight,
while the gonorrhoeal inflammation is still confined to the
region of the navicular fossa. They are caused by the pus
being absorbed by the lymphatics of the penis, which carry
it to the glands where it causes an inflammation. The development of buboes is hastened by much bodily exercise or
fatiguing efforts during the inflammatory stage of gonorrhoea.
As regards the treatment of buboes, during the early stage
of inflammation and swelling, the patient should remain as
quiet as possible, and take one of the following remedies:
Aconite, Belladonna, Carbo anim., Lycopod., Mere. sol.,
Phosph., Rhus t., Thuja.
[Aconite, more particularly, if the inflammation is very
tcute, and accompanied by fever;
Belladonna, after the fever begins to decline, and a subacute stage of the inflammation has developed itself;
Mercurius sol., if the swelling is neither red nor very sore,
and has developed itself very slowly;
Rhus tox., when the tumor is as hard as stone, and almost
insensible;
Lycopod. and Thuja, if the tumor has become chronic
after one or more of the other remedies had been used.]
If the increased redness and the presence of fluctuation
should lead us to infer that pus has been formed, the suppurative process should be hastened by the application of warm
poultices; internally one of the following remedies Which are
physiologically related to the morbid process, may be given:
Belladonna, Hepar sulph., Mere. sol., Silicea.  If the inflammation and the pain should be very violent, and the tumor
should not break voluntarily, the patient will derive great
relief from the tumor being lanced.




68      CYSTITIS.-EPIDIDYMITIS BLENNORRHAGICA.
II;  CYSTITIS, INFLAMMATION OF THE BLADDER.
This disease is not very frequent.  It arises from  the
mucous membrane of the neck of the bladder, or even the
bladder, being invaded by the gonorrhoeal inflammation. It
is generally accompanied with inflammation of the prostate
gland. The patients complain of distressing pains in the
region of the bladder, causing a good deal of oppressive
anxiety and spreading to the adjoining parts, the perinaeum,
anus, testicles, loins. The pains and the anguish are still
increased by the violent urinary tenesmus, in consequence of
which the urine can only be discharged in drops.  These
phenomena are of course accompanied by violent fever, the
patients spend sleepless and distressing nights, and lose
strength\ and flesh. The urine is turbid, and deposits a
bloody and purulent sediment.
A very strict diet is here rendered necessary by the intensity of the inflammation.  The following remedies may be
exhibited: Aconite, Acidum phosphor., Bryonia, Staphys.,
Tart. emet., and Veratr.
[The principal remedies are undoubtedly Aconite and Cantharides, which may be used alternately, in tincture form,
two or three drops of the Aconite, and one drop of Cantharides, in separate tumblerfuls of water, a tablespoonful of
each solution every half hour alternately, until the dangerous
and distressing symptoms have abated, after which the medicines may be continued at longer intervals, every hour or two
hours. If, after the subsidence of all the acute symptoms,
some strangury should still remain,
Nux vomica or Pulsatilla may be resorted to, and then
again Aconite or Cantharides, or both in alternation, until
the cure is completed.]
III.  EPIDIDYMITIS BLENNORRAAGICA, ACUTE INFLAMMATION OF THE EPIDIDYMIS.
This disease is one of the most frequently-occurring complications of gonorrhoea, and, on account of the cause whence




EPIDIDYMISIS BLENNORRHAGICA.               69
it springs, one of the most important. It is either caused by
the spread of the gonsrrhoeal inflammation along the ejaculatory canal and the vas deferens, so that the spermatic
cord is simultaneously invaded by the inflammatory process,
or by sympathy, in which case these last-mentioned organs
are not affected.  Many contend that such an inflammation
may be caused by a sudden suppression of the gonorrhoeal
discharge. This opinion is contradicted by other authorities
of the highest standing. Ricord especially asserts that the
best preventive of inflammation of the testes is a speedy
removal of the gonorrhoeal discharge; and that this inflammation occurs most frequently in cases where the gonorrhoea
had not been treated at all. Orchitis frequently occurs simultaneously with gonorrhoea, but most frequently in the last
stage of the disease.
Orchitis is more readily superinduced when the following
conditions occur: excessive afflux of venous blood to the
testes, relaxation of the scrotum, large size of the testes,
frequent voluntary or involuntary emissions of semen, sexual
excitement, or else unnatural abstemiousness, efforts and irritations of the neighboring parts by standing, walking, riding,
vesical calculi, constipation, colds, mechanical injuries such as
blows, contusions, etc. Improper medical treatment, such as
irritating injections, may likewise occasion this disease.
It generally runs the following course: after the gonorrhoea has continued for a while, the patient experiences a
sensation of pressure and heaviness either immediately in the
testes, or first in the region of the kidneys, groins, perinueum.
The pain increases, particularly if the testicle is left to its
weight, or by standing; and, if it reaches a high degree, it
extends to the thigh, abdomen and small of the back. Colicky pains set in, accompanied by urinary difficulties; even
the peritoneum may be invaded.  Sometimes the spermatic
cord swells to such a degree that it becomes constricted, and
phenomena resembling those of incarcerated hernia, develope
themselves.  If the disease is violent, there is always some
fever.  The sensitiveness of the affective parts is sometimes




70           EPIDIDYMISIS BLENNORRHAGICA.
so great that the least contact of the parts causes the patients
to faint away.
The disease runs a very rapid course, and an appropriate
treatment removes it in a few days.
The treatment is both prophylactic and curative. The prophylactic treatment prescribes a strict avoidance of all sexual
excitement from the moment that the gonorrhoea first shows
itself, and of every exposure or influence that might give rise
to orchitis. The patient should wear a suitable suspensory
until one or two weeks after the gonorrhoea has ceased.
The internal treatment is to be conducted with one or more
of the following remedies:
Aconite: Contusive pain in the testicle, with fever.
Acidum nitricum: Swelling and inflammation of the testes,
whence the pain travels to the abdomen through the spermatic cords; the testicle is painful to contact, with tearing in
the spermatic cord.
Acidum phosphoricum: Aching pain in both testes, worse
when waking or when touching the parts; burning tearing in
the left testicle, and burning in the prostate gland, with
frequent erections.
Ammonium  carbon.: Strangling pain in the testes and
spermatic cords, with sensitiveness of the testes to contact
and involuntary erections; seminal emissions preceded by a
drawing and strangling sensation in the testes.
Argentum  nitricum: Contusive pain, with enlargement
and hardness of the right testicle.
Arsenicum: Crampy cutting colic darting through the
abdominal ring and the perineum, considerable swelling of
the testicles,,phenomena resembling those of incarcerated
hernia.
Aurum: Swelling of the lower part of the right testicle,
with an aching pain when touching or rubbing the part;
aching tensive pain in the right testicle, as if contused.
Baryt acet.: Frequently recurring and disappearing swelling of the testicles.
Belladonna: Tearing in the left spermatic cord, especially




EPIDIDYMISIS BLENNORRHAGICA.              71
in the evening, in bed, previous to falling asleep; drawing in
the spermatic cord during the acts of micturition; long
stitches in the testicle which is drawn up.
Bismuth: Aching pain in the right testicle, worse when
touching the part.
Cannabis: Tensive pain in the spermatic cord and contraction of the scrotum, or contractive sensation in the scrotum when standing; sensation of pressure in the testicles, or
a pulling sensation.
Cantharides: Drawing pain in the spermatic cord during
micturition, with swelling of the scrotum.
Capsicum: Drawing pain in the spermatic card, and a
crampy pain in the testicle during and some time after micturition.
Causticum: Aching pain in the testicles, stitches in the
right testicle.
China: Painful swelling of the spermatic cord and testicle,
especially of the epididymis; tearing pain in the left testicle and in the, left side of the prepuce, a crampy-contractive
pain in the testicles and urethra, especially in the evening.
Clematis: Swelling of both testes; ascending pain in the
testicle and spermatic cord.
Cocculus: Stitching pain in one or the other testicle; violent pains in both testicles as if bruised, especially during
contact; drawing pain in the testicles.
Colocynthis: Continual violent drawing in the left testicle,
painful twitching of the testes, they are drawing up.
Ignatia: Pressure in the testicles; severe strangling sensation in the testicles, in the evening after lying down in
bed.
lodium: Swelling and induration of the testes and prostate gland.
Ipecacuanha: Twisting, drawing pain in the testicle.
Marum  verum: Descension of the right spermatic cord
towards the abdominal ring, with a sensation as if the spermatic cord were pressed; crampy sensation deep in the
abdomen, which extends to the testicles as if they had been




72           EPIDIDYMISIS BLENNORRHAGICA.
violently pressed upon; the integuments of the left testicle
feel sore when touched, as if a pain had invaded them, starting from the root of the penis.
North-pole of the magnet: Cutting and sharp drawing in
the testes; sharp stitches in the left testicle; strangling pain
in the right testicle; sharp drawing and cutting in the testicles.
South-pole of the magnet: Tearing in the spermatic cord;
pain in the spermatic cord, early in the morning, while the
testicle is hanging down relaxed, as if the cord were pulled
upon; the testicle is painful when touched; slow, fine, painful drawirg in the spermatic cord; swelling of the testicles,
and a tearing, strangling jerk in the same; at night the
testes are spasmodically drawn up.
Manganum aceticum: Aching, drawing pain in the spermatic cord, as if drawn up, and in the testicles, with a feeling of weakness in the parts.
Miagnes.: Swelling of the epididymis, and simple pain in
the same when touching it, or during motion.
Mercurius solub.: Paroxysmal drawing in the spermatic
cord; sensitiveness of the swollen testicle, which, however, is
not painful; feeling of coldness in the test'es; itching in the
right testicle; crampy, tearing pain, commencing between
the testes, afterwards penetrating into the penis and causing
a good deal of itching; drawing pain in the testicles and in
the groin; drawing with pressure, the drawing being the
most distressing.
Mezereum: Painless swelling of the left testicle, which
had been swollen in former times.
Nux vomica: Heat in the testes; stitches in the same;
contractive pain in the testicles.
Oleum anim.: Alternate swelling of one or the other testicles, with pain when touched.
Pulsatilla: Swelling of the right spermatic cord and testicles, with a tensive pain.  Drawing pains, and drawing
tensive pains pass out of the abdomen through the spermatic
cord into the testicles which are relaxed. The right testicle




EPIDIDYMITIS BLENNORRHAGICA.              73
is drawn up and swollen, with a tensive pain, whereas the
left testicle is hanging down relaxed. The testes and spermatic cords are painful and swollen, with discharge of prostatic fluid; tearing pain in the testes; the testicles hang
down very loosely, with tensive, drawing pains passing out
the abdomen into the testicles through the spermatic cord.
Rhododendron: Distressing pain in the testicles, especially
in the epididymis, when touching the parts; the testicles are
drawn up and swollen; contusive pain of the testes.
Spigelia: Stitching pain in one testicle; itching stinging
in the left testicle; itching stitch in the right testicle and in
the penis from behind forward; burning stitch in-the right
testicle and in the penis.
Spongia marina: Painfulness and swelling of the spermatic cord; long dull stitches proceeding from the spermatic
cord and striking into the testes; painful aching swelling of
the testes and spermatic cords; the testicle is painful when
touched; crampy, strangulating, contusive pain in the right
testicle.
Staphysagria: Violent, drawing-burning stitches from the
right spermatic cord to the right testicle through the abdominal ring, when sitting, walking or standing, most violent
when stooping; aching pain in the left testicle, aggravated
by walking and by contact or friction; drawing and tearing
in the right testicle, with pressure, as if it were forcibly compressed.
Sulphur: Pressure and tension in the spermatic cords and
testicles; slow tingling in the testicles, all day; sometimes a
slight buzzing is experienced in the thighs, whence it passes
to the testes, after which it recommences as before, more violently; vibratory sensation in the testicles and other organs.
Thuja: Burning stitches with pressure from  below upwards, through the scrotum and spermatic cord; drawing and
stitching in the spermatic cords and in the testicles; aching
pain in the testicles, as if contused, when walking or sitting.
Zincum: Frequent drawing in the testes, following the
course of the spermatic cord. Painfulness and swelling of
6




74              OPTHALMIA GONORRHCEICA.
the testes.  Drawing pricking pain in the testes, worse when
sitting or stooping.
IV. OPHTHALMIA GONORRH(EICA.
This affection arises from the metastasis of the gonorrhoeal
discharge to the eye, the discharge remaining either unaltered, or becoming less, or entirely suppressed. This disease
occurs more frequently among men than women, and generally affects one eye only. The conjunctiva is not much
affected, the disease generally develops itself slowly. In
blepharophthalmitis gonorrhoeica the redness and swelling
of the conjunctiva are generally very moderate; the. secretion is of the same quality as in the common blennorrhcea of
the eyes, but less in quantity, and the pain is less likewise.
In the very acute and rapidly-developed form of ophthalmia gonorrhoeica, we distinctly observe three stages. The
first stage sets in with a violent, burning itching especially
at the margins of the lids and in the canthi, accompanied by
a profuse flow of acrid tears, and considerable photophobia;
the conjunctiva is uniformly reddened, and the lids, especially the upper ones, swell considerably.  In the region
where the conjunctiva passes from the lids to the eyeball, a
good deal of vascular engorgement takes place.  Towards
the end of this stage, which generally is of short duration,
the tears become more turbid.  These phenomena are accompanied by fever, dulness of the head, coated tongue and violent thirst.
In a few days the second stage commences with considerable swelling of the conjunctiva; at first a whitish yellow
mucus, to which the tears with which it is mixed, impart a
watery consistence, is secreted; it speedily increases in quantity and thickness, assumes a greenish tint after a while,
and, in flowing down the cheeks, either inflames or corrodes
them.  The upper lid sometimes swells to the size of a hen's
egg, the lower lid is less swollen.  The pains become extremly acute, and from the eye and its surrounding parts
spread over the whole head.  The conjunctiva which looks




OPTHALMIA GONORRHCEICA.                  75
red as far as the cornea, forms a pad-shaped elevation around
the cornea, covering its margins, and penetrating even as a
dark-red mass between the lids which become everted in consequence, especially the lower.  There is a profuse secretion
of mucus from  the conjunctiva, the inflammation speedily
invades the cornea whose interstices become distended even
in a few hours, and which assumes an uniformly grayish or
yellowish appearance.
The fever, in the second stage, is of course worse; the
raging pain causes sleeplessness, and even delirium.
If this stage is not arrested by artificial means, the third
stage sets in, and with it a complete disorganization of the
cornea by suppuration. In consequence of this dqstruction the
eye frequently breaks and the whole of the contents of the
interior eye are discharged; or else ulcerations of the cornea
take place here and there.
When the third stage has set in, the pains in and around
the eye decrease, the mucus becomes less, more watery, yellowish-white, less corrosive;. the swelling of the eyelids and
of the conjunctiva decreases, the whites begin to reappear,
and the phlyctaenae of the cornea dry up.  The fever ceases
entirely, but all sorts of disorganizations remain, such as:
prolapsus of the'iris, adhesions of the iris and cornea, staphyloma, leucoma, disturbances of the visual power, dimness
of the lenticular capsule, adhesions of the capsule to the
margin of the pupil.
The course of this disease varies according to the constitution of the patient.  In young and robust persons it is
rapid, in old and debilitated individuals it runs a slow course.
The causes of ophthalmic gonorrhoea are-1, dir-ect'poisoning of the eye with gonorrhoeal matter; 2, metastasis of the
gonorrhoeal discharge to the eye after complete suppression or
considerable decrease of the discharge; and 3, spreading of
the inflammation to the conjunctiva as to a homogeneous tissue.
The opinions of authors respecting this disease'vary a good
deal.'St. Yves and Plenk consider metastasis as the only
cause of the disease.  Richter, Beer, Walther, Dupuytren,




76              OPTHALMIA GONORRHCEICA.
Schoen, Himly, attribute only the more acute form of this
disease to metastasis; Howard, Foot, Spangenberg, Ritter,
Benedict, Lawrence and others, on the contrary, derive it
from some local infection; Ricord likewise denies ever having
seen it take place after suppression of the original discharge.
It is conceded that the more acute forms of gonorrhceic
ophthalmia are caused by the gonorrhoeic poison getting into
the eye; this accounts for the fact that men are more frequently attacked by the disease than women, and that only
one eye, principally the right one, is generally affected; for
the patients are in the habit of touching the diseased parts
with the right hand, and afterwards rubbing with it the right
eye for the purpose of stopping the itching which they may
happen to experience.
Suppression of gonorrhoea is undoubtedly the least frequent cause of ophthalmia gonorrhoeica.
The prognosis in this disease is generally very unfavorable.  The visual power can only be preserved by a suitable
treatment being instituted from the commencement. If the
inflammation should be far advanced, the cornea considerably
affected, interstitially distended, covered with phlyctsenve,
considerable disturbances of the visual power can scarcely be
prevented. It is therefore advisable, according to Ricord, to
look upon every case of ophthalmia which takes place simultaneously with gonorrhoea as a malignant form of inflammation, and to institute a treatment accordingly.
As regards treatment, the use of specific remedies should
be accompanied by the observance of the strictest cleanliness.
Even in the lesser forms of the disease, the affected eye
should be used as little as possible, and should be protected
by a screen against the light.
In the commencement of the disease Aconite is an excellent remedy; in the lighter forms it alone frequently effects a
cure.
In violent inflammation, with burning pains, copious discharge of mucus, one or more from  among the following
remedies should be used: Arg. nit., Belladonna, Calomel,




OPTHALMIA GONORRHEIICA.                 77
Cannabis, Carbo veyet. Euphrasia, Graphites, Iepar sulph.,
Lycopod., Mere. sol., Nitric acid, Mercurius corrosivus, Sulphur, Tart. emet., Thuja, Verat. alb.
In inveterate cases Tussilago petasites has been found useful. In cases where the iris had become affected, which is
frequently the case when matter gets into the eye, China,
Colchicum, Euphorbium, Sulphur and Terebinth., will be
found efficacious remedies.
[The principal remedies are undoubtedly Aconite, Acidum
nitricum and the mercurial preparations, especially Mercurius
praecipitatus ruber, corrosivus, dulcis and acetatus.
Aconite, when the inflammation is very acute, and the pains
in the eye and in the region of the eyebrows agonizing, cutting, throbbing, burning, with excessive sensitiveness to the
light; after the acute pains have been subdued by Aconite,
and this agent does not seem any longer to act in the case,,
we may resort to
Belladonna, for aching, sore pains, with sensitiveness to
the light, dilated pupils, frontal headache; or
Euphrasia, when the inflammation is accompanied by a
profuse secretion of tears;
Acidum nitricum, when the anterior chamber seems filled
with a dirty-looking pus, as if the eye would become disorganized.
The mercurial preparations may be used in the following
order: corrosivus, dulcis, ruber, and lastly, acetatus, for
symptoms of disorganization, opacity or ulceration of the
cornea, opacity of the lens, distortion of the pupil. If symptoms of iritis develope themselves during the acute attack,
Aconite in alternation with Mercurius corrosivus are invaluable agents; of the Aconite, mixing three or four drops of
the saturated tincture of the root in a tumblerful of water,
and giving the corrosive mercury in grain doses of the third
trituration.]




78             GONORRH(EA OF THE MOUTH.
V. GONORRHEA OF THE BUCCAL AND NASAL CAVITIES.
It is supposed that the gonorrhoeal matter may be carried
to the nasal cavity by means of the pocket-handkerchief, and
that in consequence inflammation of and discharge from the
nostrils may take place. It appears, however, that this form
of the disease occurs very seldom. It has only been observed
by few authors.  At first the symptoms are like those of a
common catarrh; afterwards the mucous membrane swells, and
the discharge becomes purulent and profuse.
Actual gonorrhoea has likewise been noticed from the
buccal cavity.  Such cases are related by Petrosi, of Kiel,
and Sigmund, of Vienna; both men and women have had
their mouths infected with the gonorrhoeal disease by bringing these parts in contact with the contagious matter.Petrosi relates as follows: A young man was attacked with
gonorrhoea of the urethra, and, in consequence of applying
his mouth to the diseased pudendum, the buccal cavity likewise became diseased.  Already on the following day he
experienced a pain about the lips and gums. On the fourth
day the mucous membrane of the lips and buccal cavity
became intensely red; the motions of the mouth became
painful; the gums were interstitially distended, receding
from the teeth, readily bleeding, and the secretions from
the buccal cavity were more copious. Afterwards a copious,
purulent, tenacious and ropy secretion, with aphthous exudations under the tongue, and painful deglutition set in.
Professor Sigmund, indeed, admits that, in most cases, the
gonorrhoeal disease of the mouth arises from the poisonous
matter of the same person being brought in contact with
the lips; however, he mentions cases where the disease was
caused by introducing the diseased penis into the mouth of
another person, or by licking the affected pudendum with
the tongue.  Sigmund not believing it possible that human
degeneracy could reach this low level, an experienced prostitute afforded him an opportunity of being an unseen witness




GONORRH(EA OF THE RECTUM.                79
of such an act perpetrated by an old frequenter of haunts of
vice.
The strictest cleanliness is likewise required for a successful treatment of nasal and buccal gonorrhoea. The internal
treatment of the gonorrhoeal inflammation of the mucous
membrane of the nose and mouth requires the use of.Aurum,
Calearea, Hepar sulph., Pulsatilla, Phosphorus, Mercurius
corrosivus, Sulphur and Thuja.
[Aurum, when the discharge from the nose is very offensive
and the internal parts of the nose feel very sore. If this
should not help, resort to
fepar sulphuris, especially if the discharge is of an acrid
and excoriating nature; if thin and ichorous, burning,
Arsenic may be given; or, if attended with swelling, inflammation, soreness of the nostrils,
Mercurius corrosivus and Sulphur in alternation.]
VI. GONORRH(EA OF THE RECTUM.
This form of gonorrhoea may be caused by an unnatural
gratification of the sexual instinct, or in the case of females,
by the gonorrhoeal matter flowing from the vagina downwards
along the perinseum into the anal fissure; in any case, the
disease is caused, by direct contact of the poison. In the
case of females, where it is caused by self-infection, the skin
around the anus is generally inflamed, excoriated, secreting a,
turbid, purulent fluid. In large cities it is rather frequent,
particularly among prostitutes and men given to Sodomitic
habits.
Cleanliness and one or more of the following remedies will
cure the disease: Aconite, Argentum, Aurum, Belladonna,
(Jalcarea, Ignatia, Mere. sol., Natr. mur., Nux vom., Phosphorus, Sepia and Sulphur.
[Aconite, for burning, shooting pains, with soreness and
inflammation.
Mercurius, for stitching pains, with purulent discharge.
Nux vomica and Sulphur, when the symptoms are,complicated with haemorrhoids, strictures of the rectum, etc.




80  GONORRH(EAL RHEUMATISM.
Generally, the same medicines will cure the disease that are
indicated by the character of the gonorrhoeal discharge.
For metastatic gonorrhoea of the rectum, Pulsatilla, Mereurius corrosivus, and Tussilago petasites will be found most
efficacious.]
VII. GONORRH(EAL  ARTHRITIS, RHEUMATISM, ARTICULAR
INFLAMMATION, SWELLING  OF  THE  KNEE, ARTHRITIS
BLENNORRHOICA, RHEUMATISMUS GONORRHOICUS, GONITIS
GONORRHOICA, GONOCELE, ETC.
Gonorrhoeal arthritis is one of the sequelae of gonorrhoea,
which was formerly overlooked and is denied even now by
many.  Its existence is admitted, however, by such men as
Astley Cooper, Graves, Simon, Eisenmann, Lawrence, Cumano, Holscher, Rayer, Rostan, Sigmund, Hebra, etc. Even
Ricord, who denies the existence of this disease, admits that
in persons who are subject to rheumatism, gonorrhoea may
induce a gonorrhoeal arthritis or rheumatism.  Casenave has
shown, however, that an articular rheumatism which happens
to supervene during gonorrhoea, has to be carefully distinguished from gonorrhoeal rheumatism. Articular rheumatism
which happens to supervene during the existence of gonorrhoea rarely occurs at a period when gonorrhoeal arthritis
generally sets in, namely, about the fourth, fifth, or sixth
week of gonorrhoea; in most cases the rheumatism is already
existing previous to the gonorrhoeal infection taking place.
In gonorrhoeal arthritis the pain is generally seated in the
knee, sometimes in the elbow and in the tarsal joint; in rheumatism, on the contrary, every joint, even the muscles, are
affected; it is either shifting from joint to joint, or else
seated.
Gonorrhoeal articular rheumatism is generally located in
the knee-joint, and is distinguished from gonorrhoeal arthritis
by a much more intense reaction which is almost entirely
wanting in the latter. Articular rheumatism leaves the gonorrhoeal discharge almost entirely unaltered; in gonorrhoeal
arthritis it is either lessened or suppressed.




SUPPURATION OF THE- PROSTATE GLAND.           81
With proper treatment the disease lasts from three to four
weeks. According to the symptoms, one or more from among
the following list of remedies will have to be selected: Aconite, Bryonia, Mercurius sol., Nux vom., Pulsat., Rhus t.,
Rhododendron, Sulphur, Tussilago petasites; electro-magnetism is an admirable remedy in this disease.
[Aconite, if the swelling develops itself suddenly, with all
the symptoms of an acute inflammation, intense burning and
lancinating or tearing pains, excessive tenderness to the
touch, etc.
Bryonia may be substituted for Aconite when the acute
stage has subsided, and the pains have moderated; or it may
be given in alternation with Aconite.
Mercurius sol. will be found suitable, if the original discharge was of a syphilitic character, or some intensely-acting
mercurial preparation may be employed.
Pulsatilla is useful when the knee-joint is the principal
seat of the disease, with deep-seated soreness and aching
pains in the joints.
Rhus. tox. and Rhododendron may be-resorted to, if the
pains are mitigated by motion, and the inflammatory symptoms are very slight, the swelling is large and hard.]
Gonorrhoeal Disorganizations.
I. CHRONIC INFLAMMATION AND SUPPURATION  OF THE
PROSTATE GLAND.
If an acute inflammation of the prostate gland is not
speedily scattered,-and it is but too frequently the case that
the aid of a physician is only sought when this disease has
already reached its acme,-it generally terminates in suppuration, or passes into the chronic form.
Generally the patients.first complain of a painful pressure
in the perineum, and which is at first felt only during an
emission of urine or semen, but afterwards becomes continuous, and is always worse during the above-mentioned emissions. At a later period the pain increases to a burning,
extending to the glans and even downwards to the testicles




82        SUPPURATION OF THE PROSTATE GLAND.
and thighs. From the urethra an albuminous, colorless, ropy
fluid is discharged, which sometimes closes the orifice of the
urethra, is secreted more copiously after an emission of semen,
urine or after stool, and is particularly increased during a constipated state of the bowels by pressing upon the prostate
gland, by excesses in drinking or sexual pleasures, by taking
cold or by physical exertions; the pains are likewise aggravated at such periods.
Under the operation of these same causes, the urging to
urinate is likewise more violent, the irritation extends to the
bladder, the urine is expelled by fits and starts; it is mixed
with mucous flocks, the stream is sometimes divided, and a
little urine constantly remains behind in the bladder, of a
dark color, a pungent ammoniacal odor, and causing an
increased irritation of the organ. In order to be sure of a
correct diagnosis, the parts should be explored simultaneously
with the finger through the rectum, and with the catheter
through the urethra. The prostate gland becomes variously
disorganised, at times only swollen, at others harder or softer;
at times again its tissue is altered, or there are adhesions
between the prostate and the surrounding parts.
The existence of suppuration may be inferred from a constant desire to urinate, pain when urinating, and the presence
of tenacious mucous and pus in the urine.  In such a case,
the constitutional irritation is quite considerable; there are
frequent chills, febrile motions, and even delirium.  In the
perinaeal region a dull, painful throbbing is experienced.
The suppurative process is either going on in the body of
the gland, or in the surrounding cellular tissue.
The abscess generally opens into the urethra; sometimes
the discharge is accomplished by means of the catheter. The
dangerous symptoms speedily disappear after the discharge
of the pus, which is drawn off by the catheter. The pus may
likewise discharge into the bladder or rectum. In the former
case the pus is expelled together with the urine; in the latter
case, blood and pus flow out of the rectum. After the breaking of the abscess, no matter in what direction, the morbid




SUPPURATION OF THE PROSTATE GLAND.           83
phenomena, especially the retention of urine, subside, and
perfect recovery soon takes place.
If the pus cannot be discharged, which takes place in case
the substance of the gland is affected, the consequences may
be very distressing.
The following remedies will be found the most suitable in
chronic inflammation and suppuration of the prostate gland:
Arg. nitr., Aurum, Arsen., Acid. nitr., Carbo. anim., Calear.,
Capsic., Cannab., Conium, Iodine, Lycopod., Mere. sol., Nux
vom., Pulsat., Rhodod., Sal ammoniacum, Silicea, Sulphur,
Spongia, Thuja, Tussilago petasites and Uva ursi.
[Thuja is one of the most efficient remedies for hypertrophy,
engorgement and infiltration of the prostate gland, also suppuration; in a case of suppuration of this gland, reported by
Trinks, the exhibition of Thuja was followed by an increase
of the pains and of the urging to urinate, and by the protrusion of hsemorrhoidal tumors, with violent burning pains; the
disease was cured completely and in a short time by the binniodide of potash.
Arsenicum may be resorted to if the patient feels very
much debilitated by the disease'; if the disease threatens to
assume a malignant form, and a foul ichor is discharged from
the gland, with fetid colliquative diarrhoea, foul urine, etc.
MJercurius sol., if the urine contains shreds of mucus,
or deposits a chalk-like, purulent sediment, and a heavy,
aching pain is experienced in the perineal region.  The
other mercurial preparations may prove serviceable, if the
soluble mercury should fail.
The biniodide of potash has been mentioned previously as
an important agent in suppuration of the prostate gland.
Iodine may prove serviceable in induration or subsequent
atrophy of the gland.
Silicea may be used in chronic suppuration of the gland,
with heat and soreness in the gland, discharge of pus with the
urine or stool, urging to urinate, costiveness.]




84            STRICTURES OF THE URETHRA.
II. STRICTURES OF THE URETHRA.
By strictures of the urethra we understand a diminution of
the transverse diameter of this canal, owing to some morbid
alteration of its tissue.
The most frequent cause of strictures of the urethra is
gonorrhoea. This form of blennorrhoea, which does not arise
from an ulcer, and has the character of a genuine catarrhal
inflammation of the mucous membrane of the urethra, yields
to proper treatment, even in its most acute forms, in two or
three weeks, without leaving a trace behind. After such a
treatment the mucous membrane resumes its former elasticity
and dilatability, as if no discharge had ever existed.
But most patients, especially young people, are prevented
by a feeling of ill-timed modesty, from applying to a trustworthy physician, and prefer submitting to the improper
treatment of some quack.  The discharge remains uncured,
and strictures, inflammations of the kidneys or bladder, are
the consequence.  If quacking remains inefficient, a physician is applied to.  In the meanwhile the inflammation of
the mucous membrane becomes chronic, and an exudation
takes place in its tissue, in consequence of which the urethra becomes narrower, and the free emission of urine is
prevented.
After syphilitic or virulent gonorrhoea strictures of the
urethra are quite common.  This is owing to the pressure of
a syphilitic ulcer in the urethra, from which the pus is discharged.  Such ulcers are generally seated on one side of the
inner wall of the urethra, and leave a cicatrix even in the
most fortunate cases. This cicatriced tissue is constantly
disposed to contractions which likewise lead to strictures, but
different from those which result from a common gonorrhoeal
discharge.
Another cause of stricture is the varicose engorgement of
the blood-vessels of the mucous membrane of the urethra.
The engorged vessels form prominences in the urethra, generally in the region of the neck of the bladder, in consequence




STRICTURES OF THE URETHRA.                 85
of which the urethra becomes narrower and the emission of
urine is sometimes rendered impossible.
Strictures are sometimes, but less frequently, induced by
tubercles in the sub-mucous cellular tissue of the urethra.
With reference to the above mentioned causes we distinguish
spasmodic, organic or continuous and mixed strictures.
1. Spasmodic strictures are said to result from anomalous
contractions of the organic and animal muscular fibres of the
urethra. This form of qtricture is doubted by some. It is
said to occur principally in irritable individuals, haemorrhoidal
subjects, and in persons suffering with chronic inflammation
of the prostate gland.
2. Organic strictures are the real strictures of the urethra,
the treatment of which requires our most particular attention.
This class of strictures has likewise been divided into sev,
eral varieties, based upon pathological distinctions:
a. Inflammatory strictures, which develope themselves even
during the course of an acute gonorrhoea.  The mucous
membrane is swollen throughout its whole extent, owing to
which the space of the urethral canal is diminished and the
discharge of urine is less and even entirely prevented. This
kind of stricture disappears together with the gonorrhoea
under proper treatment.
b. Membraneous strictures, arising from the formation of
folds or valves in the mucous membrane.
c. Fleshy strictures, caused by a partial swelling of the
lining membrane.
d. Fibrous or cartilaginous strictures, caused by cicatrized
wounds, ulcers, fissures, etc.
e. Varicose strictures, arising from  engorgement of the
blood-vessels coursing along the inner walls of the urethra,
especially in the region of the neck of the bladder.
3. By mixed strictures we mean such as arise from a spasmodic condition and an organic ulceration of the tissues
They may likewise be caused by the insertion of a bougie
through a contracted portion of the urethra.  Riding on




86            STRICTURES OF THE URETHRA.
horseback, forced marches, excessive drinking and venereal
abuse may likewise lead to such complications.
As regards locality, the whole canal may be constricted so
as to form a narrow tube.  Spasmodic strictures are always
seated in the membranous portion, for this is the only portion
of the urethra which is surrounded by muscular fibres.
Organic strictures are most frequently located five or six
inches from the internal orifice of the urethra, directly under
the symphysis pubis, at the junction of the spongy with the
membranous portion.  They occur less frequently at the termination of the navicular fossa, or in the prostatic portion.
Let us now pass to the phenomena of a stricture.  Soon
after the termination of an improperly treated gonorrhoea
drops of mucus are discharged from the urethra, which are
only seen in the morning, when the orifice is found closed
with the mucus.  The bed-linen and the shirt exhibit dirty
yellow stains. This kind of discharge is generally termed
"goutte militaire," and is not infectious.  Such discharges
from the urethra always point to incipient strictures.
Another sign by which the existence of stricture is known,
is the thinness of the stream, always accompanied with an
increased slowness of the stream which ceases to form a curve,
but comes down in a rather perpendicular direction.
The shape of the stream is likewise altered; first it becomes
flat, and finally divides into several branches, which are
twisted about one another like a cork-screw. Sometimes the
stream scatters all around on leaving the urethra; at last the
urine comes off in drops and very slowly.
The urging to urinate is constant, and is particularly
troublesome at night. The urine is discharged with great
trouble; the patient has to press both his hands upon his
knees or upon some other hard object near by; during such
efforts the face and neck turn red, tears flow out of the eyes,
and in more inveterate cases the patients are sometimes
obliged to assume a position, when urinating, as if they
would go to stool. If this condition lasts any length of time,
hernia and prolapsus of the rectum are apt to take place.




STRICTURES OF THE URETHRA.               87
Such efforts are always accompanied by great pain.  This
pain is of various kinds, prickling, stinging, burning, itching
and more or less acute; it excites a sensation of heat, which
sometimes increases to a burning, as with a red-hot iron, and
is so distressing that the patients refrain from urinating as
long as they can in order not to excite the pain. In consequence of being retained in this manner, the urine becomes
more acrid, and causes erosions, soreness, rhagades and ulcerations behind the stricture.  At first the dysuria is only felt
during an emission of urine; after a while it continues even
after the emission.
Not only the emission of the urine, but also that of the
semen causes pain, which is sometimes so violent that the
patients dread sexual intercourse and frequently avoid it altogether.  According to the statements of some patients, the
pain which is experienced during an emission of semen is
more acute than that which an emission of urine causes.
In the course of the disease an inability to retain the urine,
or incontinence of urine, sets in.  This incontinence may be
complete or partial. If partial, a srhall quantity of urine is
discharged involuntarily drop by drop after every urinary
emission; the clothes get wet, and, after awhile, a fetid odor
is spread in spite of the utmost cleanliness. This dribbling
of the urine is caused by a quantity of urine accumulating
behind the stricture in a kind of sacculated enlargement, and
flowing off through the stricture by its own gravitation.
Complete incontinence is much more distressing and inconvenient. In this case the enlargement extends to the neck
of the bladder, on which account the bladder is unable to
retain the urine which passes off continually and involuntarily. Such unfortunate patients have to wear a receiving
vessel fastened to the parts.
The most horrible accompaniment of strictures is retention
of urine, which really endangers life.  Inasmuch as this
affection may likewise arise from other causes, we will recur
to it in a special section.
The alterations which occur in the quantity and quality of




88            STRICTURES OF THE URETHRA.
the urine in strictures, require to be examined. The quantity
of the urine does not differ much from that of the urine in a
normal state of health. It is lessened if the patients, in
order to avoid the necessity of emitting it on account of
the great pain, endeavor to diminish the natural quantity
of the urine by diminishing the quantity of the beverage
which they are in the habit of drinking.  This, however,
does not diminish the urinary tenesmus; for, owing to the
diminution of the quantity of the beverage, the urine becomes
more salt and irritating than it was formerly.  The urging
is more frequent, very painful; stranguary sets in, and the
urine is discharged in drops.
The quality of the urine is altered in this, that it contains
a greater amount of salt and ammonia than in its healthy
condition; it is moreover mixed with pus and mucus; after
standing for a time, a cloudy, dirty white precipitate goes
down, and a pungent, disagreeable, ammoniacal odor emanates from the urine.
Beside these symptoms, an exploration of the urethra by
means of the catheter completes the certainty of our diagnosis as to the existence of a stricture.
This exploration may either be instituted with inflexible,
metallic, or with flexible, soft catheters, termed bougies. We
omit a description of the mode in which the catheter is to be
introduced; physicians may consult surgical works in reference to this subject, and laymen will probably not venture on
such an operation, which requires a good deal of dexterity
and practical experience. This same remark applies to the
various forms and the materials of probes.
We will simply state in this place, that a catheter or bougie is to be introduced, if we desire to find out the number,
locality, length, form and condition of the strictures, and
that the thickness of the bougie should be proportionate to
the size of the stream.,The course of a stricture is very irregular; it may be
shortened or prolonged by natural disposition, a suitable
mode of life, anid by various diseases. The stricture is gene



STRICTURES OF THE URETHRA.                89
rally made worse by errors in diet, an exciting mode of life,
and by venereal excesses. A  stricture never gets well of
itself, but is always disposed to terminate in a complete
closing of the urethra, and consequent retention of urine.
To prevent this result, a seasonable treatment is absolutely
necessary.
The prognosis is generally doubtful, especially if a suitable
treatment is not instituted in season. It likewise depends
upon the seat and the condition of the stricture. The nearer
it is to the outer portion of the urethra, the more recent, the
more dilatable, the less extensive and contracted the stricture,
the sooner it is removed.  Complications and constitutional
derangements increase the difficulty and render the prognosis less favorable.
In regard to treatment, I do not think that homoeopathic
physicians will be able to dispense with mechanical means.
Spasmodic strictures can indeed be removed by internal
treatment permanently and without pain; likewise other
kinds of stricture, provided the disorganization of the mucous
membrane is not too far advanced; in such a case the specific remedial virtues of our drugs may yet succeed in effecting a resolution of the morbid alterations of the tissue of the
urethra.  But if the disorganization has assumed a fibrous
character, manual interference is indispensable.
In the treatment of spasmodic strictures, and of the lighter
forms of swelling of the mucous membrane of the urethra,
the following remedies will be found the most suitable, according as the symptoms may require: Agaricus, Agr. nitr.,
Argilla, Belladonna, Bismuth, Camphora, Clematis, Con.
mac., Silicea, Kali, Petrol., Dligit., lodium, Nitric acid,
Opium, Stramon., Terebinth, Thuja. (Cantharides, Mercur.
sol. and Sulph. should not be omitted.-ED.)
[The principal remedies for spasmodic strictures, with their
symptomatic indications, are:
Aconite: with inflammatory fever; constant and distress
ing urging to urinate, with inability to pass any urine.
7




90            STRICTURES OF THE URETHRA.
Cantharides: For similar symptoms, with discharge of a
few drops'of blood instead of urine.
Belladonna: For frequent urging, the urine looking natural
or gold-colored, with cerebral congestion, and costiveness.
Camphora: Strangury, burning of the urine, thin stream.
Digitalis: Continual desire to urinate, emitting only a few
drops each time, with sensation as if the bladder were too
full; or pressing and burning in the middle of the urethra as
if too narrow.
Argentum nitricum: Burning urine, pain in the urethra
as if swollen and closed.
Nux vomica: Painful, ineffectual desire to urinate.
Opium: Spontaneous interruption of the stream  when
urinating; or complete suppression of the urinary secretion.
Terebinthina: Dysuria, also complete suppression of urine,
also with painful erections.
Thuja: Difficult micturition; the stream  is arrested half
a dozen times before the urine is entirely voided.]
In organic strictures, a surgical operation is unavoidable.
Before, however, resorting to it, we have to distinguish
between strictures which allow the urine and the instruments
to pass, and such as do not, or only with great difficulty.
This second variety:will be discussed more fully in the article
on retention of urine, section of the diseases of the urinary
organs.  For the present we will simply mention the various
operations which are employed with success for the purpose
of effecting the dilatation of the contracted urethra.  They
are
1. Simple dilatation;
2. Cauterization; and
3. Incision.
1. Dilatations.
This method is the one which is most generally employed,
and which I likewise prefer, for it has never failed me in my
practice which has been pretty extensive. Some employ for
this purpose metallic, others flexible bougies. The bougie




STRICTURES OF THE URETHRA.              91
may either be left in the urethra for a longer period, (permanent dilatation,) or a momentary introduction may suffice
(temporary dilatation). I prefer the use of elastic bougies
made of caoutchouc and gutta percha.
The size of the bougie should be proportionate to the size
of the stream.  At first thin bougies should be used, and
their size should be gradually increased.  Holding the bougie
as we do a common writing pen, we cautiously introduce it
into the uiethra. It may happen that, before reaching the
stricture, the bougie is arrested by a fold of the mucous
membrane, or by one of the mucous follicles situated along
the lower wall of the urethra. In such a case the bougie
is to be drawn back, and the penis to be pulled forward
for the purpose of removing the obstacle. If the stricture
is reached, we endeavour to work the bougie through the
narrow opening; if we do not succeed, a thinner bougie has
to be tried. We must not lose courage, if we find it hard to
overcome the difficulty; with skill and perseverance we shall
finally gain our object. If, after passing the bougie. into the
narrow opening, the obstacle remains nevertheless unconquered, we have to attribute the difficulty to the windings of
the stricture.   This new obstacle is overcome by turning
the bougie irregularly in different directions, until we finally
succeed in penetrating the bladder.
In order to be perfectly satisfied whether the bougie has
really penetrated the stricture, we hold it quite loosely between
the fingers; if the stricture is passed, the bougie will remain
in its place; if it is simply bent in the urethra, its elasticity
will cause it to bound back again.
If the canal should be very narrow, it is sometimes an
advantage to inject sweet almond oil into the urethra.
The bougie may be introduced once or twice a day. At
every new trial, the bougie which had been used last, and had
been introduced with ease, has to be used again, and to be
left five or ten minutes in the urethra, before we replace it by
one of larger size.
The length of time during which the bougie should be




92            STRICTURES OF THE URETHRA.
allowed to remain in the urethra, depends upon the patient's
own feelings.  Some bear the presence of the bougie for an
hour; very irritable and sensitive persons are frequently
made sick, if the bougie is left too long. This sensitiveness
decreases however after repeated trials.
At the commencement of the treatment, the bougies should
not be changed without great caution. Bougies of larger size
should only be used after a considerable dilatation of the
stricture has taken place.  The operation of the bougie is
materially arrested by a few doses of Belladonna, Clematis
or Thuja.
After using the bougie and the suitable remedies for about
three weeks, the patient is generally cured, and the stricture
together with all the diffiulties in voiding urine, removed.
However it is not well to discontinue the use of the bougie
immediately; on the contrary, it is advisable to continue the
use thereof for sometime longer.
In the case of sensitive and irritable persons, who suffer
much pain from the introduction of the bougie, one or two
days should be allowed to elapse before another introduction
of the bougie is attempted, until the parts have become less
irritable. If, in spite of all care and trouble, we should not
succeed, upon a first trial, in introducing a bougie, were it
ever so thin, the introduction of the instrument may be
attempted while the patient is in a tepid bath. Sometimes
we will find it more easy to introduce a bougie of larger than
one of a smaller size.
The dilatation of the urethra by means of a bougie has
several advantages. 1st, a mechanical enlargement of the
stricture; and 2d, a restoration of the depressed. vitality of
the urethral mucous membrane, an increased activity of the
reproductive system, and consequent absorption of the adventitious growth.
The symptoms are likewise favorably altered by the use of
the bougie. Even after its first introduction, the urine is
voided with more ease, and the patient is very much relieved.
As the stricture is more dilated, the stream increases in




STRICTURES OF THE URETHRA.              93
size, the urine is voided in less time, and the last drops even
are properly expelled by the bladder, instead of the former
dribbling.
On first introducing the bougie, the mucous discharge is
somewhat increased; but it decreases in proportion as the
stricture dilates, and finally ceases altogether.
The urging to urinate disappears already after a few trials.
This enables the patient to have a quiet rest at night, by
which means the general health is improved and the cure facilitated.
The efforts which the patient had to make, in order to void
the urine, and the pain which he experienced during micturition or during an embrace, decrease likewise after several
introductions of the bougie. The dribbling of the urine, and
the ischuria likewise disappear, provided, however, the latter
disease did not arise from any other cause.
The urine becomes clearer after awhile; it is no longer
mixed with blood and mucus, loses its pungent, ammoniacal
odor, and the sediment gradually disappear.
We have to devote a few remarks to permanent dilatation;
which, though less desirable than the temporary dilatation,
may nevertheless be rendered necessary now and then by
circumstances. This is particularly necessary when the physician is prevented from seeing his patient every day. For
the permanent dilatation we generally use an elastic catheter.
The instrument is introduced in the same manner as the
bougie, and, after having penetrated the stricture, it is fastened to the abdomen by means of a thin string, and left in
this position until the next day, so that it can be easily moved
to and fro in the stricture. Next day we use a catheter a
little larger in size, and which it is difficult to pass through
the stricture. Every second or third day we select a catheter
of a somewhat larger size, until the urethra has acquired its
normal diameter. The outer orifice of the catheter is closed
by means of a little tampon which the patient removes himself when he desires to void urine. If the physician should
be unable to see his patient every day, or if the patient should




94            STRICTURES OF THE URETHRA.
live at a distance, the patient may introduce the bougie himself after being shown how.
2. Cauterization.
Without having the least desire to say a word in favor of
this method, we do not deem ourselves authorized to omit it,
were it for no other reason than because it is not long since
it was universally practised. This method of treatment may
be traced as far back as Ambrosius Pare, towards the middle
of the sixteenth century. Two hundred years after this period
it was superseded by the method of dilatation, until revived
again by Hunter about the middle of the last century. Ducamp is the one who has most distinguished himself in the
treatment of strictures by cauterization.  Owing to his efforts
and example, it became almost the exclusive method of treatment of strictures of the urethra during a period of ten years
from  1820 to 1830.  It was soon found, however, that this
method did not obviate the liability to relapses caused by the
contracting cicatrix.  On this account it was opposed by a
number of modern physicians, and finally had to give way
again to the method of dilatation.
The caustic is applied in the following manner, After
having explored the locality and extent of the stricture, the
caustic is applied by means of a canula of gum elastic, platina,
gold or silver, to the end of which a little capsule of platina
filled with liquid nitrate of silver is attached. A rod is riveted
to the capsule, by means of which it can be moved to and fro,
and turned about.  At its extremity, or on the sides, the
canula has openings through which the caustic is brought in
contact with the stricture.  To the canula is attached a graduated scale marked with figures, by which we can ascertain
how far the capsule has penetrated in the urethra.  The
caustic remains in contact with the stricture for half a minute
or a whole minute, after which the rod with the capsule, and
finally, the whole instrument is withdrawn.  On the second
and third day, bougies are introduced for the purpose of
dilating the canal and facilitating the coming off of the scurf.




STRICTURES OF THE URETHRA.               9,5
This proceeding is repeated every three or four days until the
obstacle is entirely removed. To complete the cure, bougies
are used in order to secure a proper dilatation of the urethra,
and this method is continued until the wound is completely
cicatrized.
3. Scarification, Operations with Cutting Instruments.
This method is as old as any of the former.  Ambrosius
Pare likewise resorted to it, and employed for his purpose an
instrument which he termed queue de ret.  Later surgeons
employed for this purpose trocarts; Amussat invented an
urethratome and scarificators.  Modern surgeons, such as
Diondi, Dieffenbach, Pauli, Stafford, Tanebon, Despiney,
Martial, Duynerris and Ricord, have contrived variousinstruments for the division of strictures.  The most simple instrument is undoubtedly that of Ricord consisting of a tube containing a stiletto with a small blade, which can be pushed out
ad libitum.
Before this instrument can be employed, the stricture has
to be sufficiently dilated by means of bougies, to admit of the
passage of the instrument. The instrument, closed and well
oiled, is passed through the stricture, and the stiletto with its
blade having been pushed forward, the stricture is divided
several times, from before backwards,'and from behind forwards. To prevent the premature adhesions of the incisions,
bougies have to be introduced.  The operation has to be
repeated until the difficulty is entirely removed,
On account of the many inconveniences consequent upon
this operation, among which the haemorrhage which sometimes accompanies it, and is sometimes quite considerable, is
not by any means one of the least troublesome, it, as well as
the treatment by cauterization, has been abandoned by most
physicians, so much more as its results are not more promising
than those of the method of dilatation.  It is only resorted
to now-a-days in the case of valvular strictures, or such as
are located in the anterior portion of the urethra.




96                    FLUOR ALBU9.
Gonorrhaea of the female, fluor albus, leucorrhoea.
Leucorrhoea is an affection of the female organs analogous
to the gonorrhoea of the male, and, by many physicians, is
looked upon as a variety of syphilis. This, however, is no
more true than that every form of gonorrhaea is a syphilitic
disease.
The female organs are much more frequently affected with
blennorrhoea than the male, probably because the mucous surface of the former is more extensive, and the inflammatory
irritation may invade several organs. On this account four
varieties of female gonorrhoea have been adopted: 1, urethritis, inflammation of the urethra; 2, vulvitis, inflammation of
the vulva; 3, vaginitis, inflammation of the vagina; 4, uteritis, inflammation of the uterus. We will define each of these
four varieties more in detail, as soon as the course of female
gonorrhoea generally shall have been treated of.
A few days after an impure coit, a heat, burning and drawing are experienced in the parts; the mucous membrane is
drier than usual, and very sensitive, and of a dark red color
either throughout its whole extent or only in some of its parts.
The large, and afterwards the small labia begin to swell. The
rubbing of the clothes in walking causes a pain; the pains during micturition are still more distressing, particularly when the
last drops flow over the inflamed mucous membrane. Soon
after, the patient complains of pains in the small of the back,
especially when sitting. A sense of tension, tickling, and
very frequently an irresistible desire for an embrace, a real
nymphomania set in.  Coit is, however, painful.  Many
women experience, moreover, a languor, a tearing in the extremities, especially in the thighs, and colicky pains. These
phenomena generally cease after the appearance of the discharge. This is at first watery, yellowish, turbid, and sometimes mixed with blood, and leaves a grayish stain on the
linen.  Afterwards the discharge assumes a dark yellow,
greenish color, becomes thick, has an offensive smell, and is
so copious that it flows down the thigh on walking or rising




FLUOR ALBUS.                     97
from a seat. When the inflammation decreases, the discharge
becomes whitish, milky, sometimes very thick, cheesy, and
flocculent. At first the mucous membrane looks red, and is
marked with roundish spots'or streaks, which afterwards
change to erosions. After the disease has lasted for a time,
the follicles begin to swell and become prominent, imparting
an uneven and granular feel to the mucous membrane.  At
the commencement of the menses the pain gets worse, and the
discharge increases a good deal. During the menstrual flow,
however, the pains abate, and reappear again as before, after
the cessation of the menstrual periods.
As regards the causes, and disposition to female gonorrhoea,
the remarks we have offered concerning this disease in the
male, are likewise applicable to the female.  Every cause
which is capable of causing an inflammation of the mucous
membrane is likewise capable of causing an inflammation with
a mucous discharge in the pudendum. The habitual exposure
of the female parts to the atmospheric air increases their
liability to disease.  Hence leucorrhcea may be caused by a
variety of influences, and may affect every age.  There are
even cases where a copious discharge of mucous from the
pudendum  has been observed in infants during their passage
from the womb into the light of day. It frequently happens
that girls are attacked with leucorrhoea during the period of
dentition, accompanied with considerable pain; also during
the course of many eruptive diseases, scrofula, etc.
-Blennorrhoea of the pudendum  may arise from a variety
of irritating causes, from onanism, premature sexual intercourse, especially when the vulva is too small, excessive
sexual intercourse, mechanical injuries, foreign bodies in the
vagina,* such as the pessary. It is quite common, even among
perfectly healthy women, that they should have a leucorrhoeal
discharge shortly before and shortly after the period.  A
* Some time ago I treated a girl of 17 years for leucorrhcea, which had
been caused by the girl having rubbed the vagina for a considerable period
of time with a carrot, which had been introduced for that purpose into the
vagina.




98                     URETHRITIS.
similar discharge takes place during the last weeks of pregnancy and at the critical age when the menses are about to
stop. In large cities most women are troubled with leucorrhoea to some extent, which is probably attributable to the
weather, to their mode of dressing and living, to excessive
reading, to sedentary habits and other circumstances. Coffee
with milk is likewise supposed capable of causing leucorrhoea.
Gonorrhoea may likewise be caused by an infectious contagion, without, however, being syphilitic, and without causing
chancrous ulcers.  In the case of the female it is indeed
more difficult than in the case of the male, to ascertain the
contemporaneous existence of syphilitic ulcers and the leucorrhoeal discharge, hence a mistake is not so very difficult.
The infection of the gonorrhoeal contagion generally takes
place during coit. It may likewise take place by the female
parts being barely touched by the diseased penis. In order
to be perfectly certain of the true nature of the discharge in
the case of females, it is absolutely necessary to explore the
parts by means of a speculum; otherwise the physician
might be left in the dark and miss the cure.
Before we proceed to the treatment of leucorrheea, we will
consider each of the four forms of leucorrhoea distinguished
with reference to the particular seat of the disease.
I. URETHRITIS.
If the inflammation is located in the urethra, it is first
revealed to us by itching, pain, swelling of the orifice of the
urethra, urging to urinate. It scarcely ever exists by itself,
and is generally accompanied by inflammation of the labia
and the vagina. It is readily recognized by the drops of pus
which are seen at the orifice of the urethra. Immediately
after voiding urine or washing the parts, the traces of the
inflammation have to be looked for on the linen which the
patients wear on their persons. We see on the shirt small,
isolated, opaque spots of a yellowish-green color. In order
to be perfectly sure of the character of the disease, we have
to institute an examination per speculum, and by the touch.




VULVITIS.                      99
For this purpose the index-finger id introduced into the
vagina, and the urethra is compressed from behind forwards
and upwards, by which means a yellowish, thick mucus is
pressed out of the orifice of the urethra.
II. VULVITIS.
This inflammation is recognized even after a superficial
examination of the parts, and is the same as the balanorrhoea
of the male. If the inflammation is very acute, the swelling
of the labia sometimes encroaches upon the orifice of the
vagina. The small labia are oedematous; they constitute a
thick, bluish-red, shining, disk-shaped  swelling, and are
covered with a number of erosions; likewise the clitoris and
its surrounding parts. The labia majora are tense, dark-red
and very prominent.  The contact of the urine causes much
pain, and the introduction of the speculum is impossible.
The follicles are swollen, and constitute more or less considerable prominences which sometimes terminate in suppuration,
constituting the so-called abscessus pudendi.  When the labia
are intensely inflamed, the warmth of the bed becomes intolerable, fever sets in, and the patient is tormented by thirst and
sleeplessness.  On examining the parts, we discover a viscid,
purulent fluid of a specific odor, which sometimes dries up in
the hair of the pudendum, forming a thick, crusty covering.
Sometimes this secretion is so acrid that the external surface
of the labia majora, the perineum, anus, and even the thighs
become inflamed, excoriated, and likewise secrete a purulent
fluid.
Corpulent women are particularly predisposed to this kind
of leucorrhoea.  Such patients find it troublesome to walk;
their sexual instinct is generally more active, but the sexual
act itself is painful.  In the case of little girls, leucorrhoea is
either the result of some internal disease, or more frequently
of mechanical injuries, touching, rape. Andrieux de Brionde
states that newly-married women frequently experience stinging pains in the pudendum the first days after their marriage,
whieh he attributes to an unusual desire for sexual intercourse.




100                     VAGINITIS.
Onanism is a frequent cause of the disease. As long as this
vice is indulged in, the disease will of course continue. The
most careful watching, the most serious exhortations, even
punishment, are frequently insufficient to stop this vile practice. Durand Tarvel relates the case of a girl of nine years
whose clitoris was removed by the knife, in order to stop this
destructive habit. The operation was very painful. In order
to arrest the haemorrhage, the actual cautery was applied;
but scarcely had the wound been healed when the child
resumed its former habits.
III. VAGINITIS. INFLAMMATION OF THE VAGINA.
This disease is more frequent than inflammations of the
external parts. It is generally accompanied with blennorrhcea
of the labia. The inflammation is either seated in the superficial mucous membrane, or in the mucous follicles or bursae;
if very acute, the whole substance of the mucous membrane
and the subjacent sub-mucous cellular tissue'may be invaded.
In such a case women sometimes complain of pain in the
pelvis, heat, and sense of weight in this region; intense heat
in the vagina, pains which frequently strike to the renal
regions; all these symptoms are worse during a walk, at
stool, and when voiding the urine. The sexual desire is generally more intense, and may be gratified without pain, provided the inflammation is not too acute.  The mucus is discharged in quantities.  Either the whole vagina or only a
portion thereof may be affected. If the follicles are principally invaded, we distinguish a number of miliary granulations with the finger. In every case of this kind the mucous
membrane is redder than usual, partially denuded of its
epithelium, and covered with small, superficial ulcers. A
mucus which is frequently mixed with blood, and pus are
secreted; this secretion has an acid reaction, and leaves yellow or yellowish green spots on the linen.




UTERITIS.                    101
IV.~ UTERITIS. INFLAMMATION OF THE UTERUS.
The catarrhal inflammation of the uterus is the most obstinate form of leucorrhoea, and the most distressing in its consequences. It is accompanied with considerable derangements
of the menstrual functions, violent haemorrhages, difficult conception, degeneration of the fetus, disposition to miscarriage,
and even complete sterility and obliteration of the Fallopian
tubes, as is frequently observed in prostitutes.  This inflammation is recognized by redness and dryness of the neck of
the uterus. The neck is covered with a whitish, thick, adhering mucus, secreted from the internal orifice of the womb or
from all the surrounding parts. The patients complain of
heaviness and drawing in the pelvis and small of the back,
and, on sitting down, frequently experience a burning pain.
Erosions soon develope themselves round the os tincae, with
superficial, uneven ulcerations, which are covered here and
there with whitish patches of dead epithelium. Sometimes,
and particularly in the case of prostitutes who do a large
business, inflammation spreads to the inner surface of the
uterus, the Fallopiant ubes, the ovaries and the peritonaeum;
in such a case life may be endangered by the inflammation.
In treating female gonorrhoea homoeopathically, we have to
consider the seat and extent of the disease, the accessory
symptoms which happen to accompany it, and the general
condition of the patient. Accordingly, we may have to use
one or more of the subsequent list of medicines, either alone
or in alternation, or several medicines in a successive series;
the selection of the remedy will of course depend upon the
symptoms and state of the disease.  We will relate these
remedies in alphabetical order, and mention the group of
symptoms to which each medicine is specifically adapted.
Acid. nitr.: Flat ulcers in the vagina as if covered with a
yellow pus; with a burning, itching pain and leucorrhoea. Discharge of a flesh-colored mucus from the vagina. Swelling at
one side of the vagina. (This remedy is particularly adapted
to chronic vaginitis.)




102                     UTERITIS.
Acidum phosphor.: Leucorrhoea before  and  after the
menses, with burning in the urethra.
Acidum sulphur.: Milky, transparent leucorrhoea, painless,
but sometimes smarting and mixed with blood, acrid, copious
and erosive.
Aconitum: Leucorrhoea, with slight tingling in the parts
which is not disagreeable.
Arsenicum: Smarting, gnawing leucorrhoea, causing a soreness of the parts with which it comes in contact; when
standing the discharge drops down, accompanied with emission of flatulence. Redness of the parts.
Aurum: Profuse leucorrhoea which excoriates the perinaeum, and the internal sides of the thighs, with vesicular
eruption on the parts and back, labor-like pains in the abdomen as if the menses would make their appearance.
Belladonna: Violent dragging towards the sexual parts as
if every thing would issue from  the abdomen, worse when
walking and sitting bent; she feels easier when sitting erect.
Bloating of the abdomen, followed by contraction of the same,
and by discharge of white mucus from the vagina, violent
stitches in the pubic region and the inner parts, at every step
she makes, (vaginitis.)
Bryonia: Black, hard pustule on the swollen labium.
Swelling of the labia majora. Increase of the discharge which
had been decreasing, (vulvitis.)
Calaear: Burning, jerking leucorrhoea previous to the
menses, flowing out like milk. Smarting between the genital
organs and thighs. Pressure in the vagina, and tubercles on
the labium.
Cannabis: Cutting between the labia during micturition.
The orifice of.the urethra is closed with a drop of pus. Violent sexual desire with swelling of the vagina. The discharge
causes a smarting of the parts which it touches, (urethritis.)
Cantharides: Copious, debilitating leucorrhoea, with pains
in the kidneys and a distressing feeling in the pelvis, accompanied with a languid, sallow complexion, depression of spirits,




UTERITIS.                     103
swelling of the neck of the uterus. Burning and itching of
the pudendum, (chronic uteritis.)
Chamomilla: Yellow, smarting leucorrhcea from the vagina.
Acrid, smarting, watery discharge from  the vagina, with
smarting, burning as if the parts were excoriated.
Crocus: Leucorrhcea accompanied by paroxysms of acute
stitches from the pudendum to the right thigh, as if a knife
were thrust into these parts every now and then, suddenly,
gradually penetrating into the parts, and with increasing
pain.
Graphites: Profuse leucorrhoea in the vagina and painful
pressing towards the pudendum.
Ignatia: Violent crampy pressure in the uterus, followed
by purulent, corrosive leucorrhoea. Chronic leucorrhcea with
excited sexual desire. Swelling of the clitoris with weakness
of the remaining portion of the pudendum; coolness of the
body, and uterine spasms. (Chronic uteritis.)
Kreasotum: Bloody, flesh-colored, yellow  or yellowishwhite, leucorrhoea, having a foul smell, especially early in the
morning, after rising.  Acrid discharge, with itching of the
pudendum; jerking, smarting pain in the external parts, and
weakness of the legs. (Vagina, &c.)
Lamium: Copious leucorrhoea, coming off in drops, with
smarting in the pudendum.
Lycopodium: Copious, bloody or milky leucorrhoea, coming
off in paroxysms, worse before the full moon, with burning in
the vagina. (Vaginitis.)
Mercurius solubilis: Mild leucorrhoea, of a pale, yellow
color, and a sickly, sweetish odor.  Discharge of flocks, pus.and mucus, of the size of hazle nuts.  Purulent leucorrhoea,
which does not drop, of a green color, causing a smarting in
the anterior portions of the pudendum, which obliges the
patient to scratch, especially in the evening and at night;
the scratching is followed by a violent burning. Corrosive
leucorrhoea with long, lasting itching of the labia, especially
shortly before the menses.  Pressing in the pudendum, after
which the patient has to void a quantity of urine.  Swelling




104                    UTERITIS.
of the follicles of the labia. Swelling and inflammation of
the internal vagina, as if raw and sore.  (Vaginitis and vulvitis.)
Mezereum: Albuminous leucorrhoea.  Mucous discharge
from the urethra and vagina.
Natrum muriaticum: Greenish leucorrhcea, passing off
profusely during a walk, with itching of the pudendum; the
discharge is preceded by contractive colic, and a pressing
downwards.  Aversion to an embrace.  Discharge of blood
after an embrace, followed by a feeling of ease, and finally,
irritable and peevish mood.  Painful pressing towards the
pudendum.
Nux vomica: Painless discharge of yellow mucus from the
vagina. Discharge of fetid mucus from the vagina. Burning
in the pudendum, with violent sexual desire. Gnawing, itching eruption on the pudendum. Swelling of the inner Vagina,
with burning pain, rendering contact intolerable. (Vaginitis.)
Phosphorus: Leucorrhoea with stitches from the vagina to
the uterus.  Aversion to coit.  Leucorrhoea instead of the
menstrual discharge; milky leucorrhoea early in the morning
when walking.  (Uteritis.)
Platina: Leucorrhcea, with pinching in the abdomen, followed by pressing downwards in both groins, alternated by
pressure in the pudendum, and increased discharge of blood.
Painless, not disagreeable pressure in the lower portion of the
pudendum, preceded by a voluptuous tingling in the parts.
Painless sensitiveness, and continual pressure in the inner
parts, and in the region of the mons veneris, accompanied with
an almost unceasing internal chill, and feeling of coldness
externally to the hands. Gnawing soreness, as if excoriated,
on the left side of, and near the pudendum.  Voluptuous,tingling in the pudendum, accompanied by a similar, though less
perceptible sensation; oppressive anxiety and palpitation of
the heart, followed by a painless, not disagreeable pressure
in the pudendum, with a languid feeling, and stitches in the
fore part of, the head. (Uteritis.)
Pulsatilla: Painless leucorrhoea; discharge of a thickish




UTERITIS.                     105
milk-colored mucus, which is especially perceptible on lying
down. Milky leucorrhoea with swelling of the labia. Leucorrhoea with burning pain. Acrid, thin leucorrhoea. Burning,
stinging pain in the labia and vagina. Cutting pain at the
os tingae. (Vaginitis.)
Sabina: Discharge of mucus and blood from the vagina,
with labor-like pains. Sharp stitches in the posterior portion
of the vagina.  Habitual leucorrhoea of the consistence of
starch, yellowish, ichorous, fetid, accompanied with, painful
discharge of blood, almost every fortnight, having a foul smell'like old serum. Copious, milky leucorrhoea, causing an itching. Itching of the sexual organs. Increased sexual delight
during coit.  Discharge of blood between the periods, with
sexual excitement. (Vaginitis and vulvitis.)
Sepia: Leucorrhoea, with itching in the vagina. Watery
leucorrhoea. Discharge of blood after an embrace, or only
when walking.  Itching of the pudendum.
Stannum:  Discharge of transparent mucus from  the
vagina, with smarting.
Mercurius corrosivus: Pale-yellow  discharge from  the
vagina, of a nauseous sweetish smell.  Pressure at the os
tinge during coit.
Sulphur: Profuse leucorrhoea.  Smarting, burning, thin
leucorrhoea, especially early in the morning after rising.
Yellow, excoriating discharge from the vagina, accompanied
with palpitation of the heart and heat in the face during
motion, and followed by burning in the abdomen. Burning
of the external pudendum, accompanied by blisters. Violent
itching of the clitoris.
Thtuja: Leucorrhoea from one period to the other; it is
mild and leaves yellowish-green stains on the linen. Mucous
discharge from the urethra. Contractive and pressing pain
in the pudendum when sitting or rising from a seat. Smarting pain in the pudendum as if the parts were sore, especially
during micturition.  Stinging in the pudendum when walking. Whitish ulcer on the inside of the labia majora, first
causing a pain as if sore when touching it, afterwards itching.
8




106     TRUE VENEREAL OR SYPHILITIC DISEASES.
Swelling of both labia, with burning pain only when walking
or touching the parts. Smarting and itching of the pudendum, principally in the urethra when voiding urine, and even
afterwards. (Urethritis and vulvitis.)
Zincum: Discharge of thick mucus, especially after stool.
Constant yawning, with pinching in the abdomen previous to
the discharge. Excited sexual desire, especially at night, without lascivious dreams. Terrible desire for self-gratification.
True Venereal or Syphilitic Diseases.
The essence of syphilitic diseases is as yet little known.
Pathologically we know that in its first stages it is an inflammation of certain parts of the skin or mucous membrane,
which runs a course strikingly analogous to the phenomena
caused by violent animal poisons, such as the poison of small
pox, dead bodies, etc.
We have already stated that the first symptoms of syphilitic
inflammation develope themselves at the spot where the infectious matter is first communicated to the organism.
This inflammation consists in an inflammation of the follicles, and in ulcerations from which a lardaceous, contagious
matter is secreted. At this stage the disease yields readily
to proper treatment.  If the parts round the ulcer have
already become hard, it is scarcely possible to avoid a constitutional disease. Afterwards the inflammation spreads to
the next lymphatic vessel and to the glands appertaining
thereto, and in some cases, produces a poisonous and infectious secretion, even in these parts. This is the commencement of constitutional syphilis, characterised  by specific
inflammations of the mucous membrane and the dermis in
remote parts, and, although no longer capable of producing.
contagious matter, yet still transmissible to the succeeding
generation in congenital syphilis. This is Ricord's view.
But Sigmund, of Vienna, and Waller, of Prague, have shown
that secondary syphilis is still able to infect others, and to
develope in them analogous phenomena. It is only at a later




PRIMARY SYPHILIS.                  107
period that the syphilitic disease recedes from the dermis and
from the mucous membrane, and, under the form of tertiary
syphilis, invades the inner tissues, the fibrous membranes
and bones, where it manifests itself in the stage of lentescent inflammations, generally in, a circumscribed space, in
the shape'of nodes, nodous excrescences, tophi, etc., forming peculiar and characteristic, but not contagious morbid
products.
Accordingly, considering the internal essence of syphilis,
we distinguish two forms of this disease, 1, primary syphilis,
or the local inflammation produced by the first and direct
action of the contagious; and, 2, constitutional syphilis, where
the whole organism is under the influence of the syphilitic
miasm, and of which we again distinguish two forms: A,
secondary, and B, tertiary syphilis.
Primary Syphilis.
Most frequently the syphilitic poison is communicated
during coit, by the contact of a sound part with one that is
diseased. The infection takes place so much more readily as,
during this sexual orgasm, the secretion of the contagious
matter, and its absorption by the healthy organs, are considerably increased.  In the majority of cases the primary
inflammation affects the mucous membranes of the sexual
organs, anus, mouth and nipples. It may likewise occur in
the eye or nose, in consequence of syphilitic pus getting accidentally to these parts. The syphilitic poison may likewise be
transmitted to excoriated parts, wounds or sloughs. Syphilitic
ulcerations are frequently seen in small wounds on the fingers,
which happened to touch the diseased organs of the same individual. Infection may take place in dressing syphilitic ulcers
or during a surgical operation.  Sometimes the syphilitic
disease is communicated to the infant by the nursing mother,
and vice versa. It may likewise be communicated during the
passage of the child through the vagina, or by kissing a person, although in the latter case, the mouth or tongue had
generally been infected by being applied directly to the dis



108                 PRIMARY SYPHILIS.
eased organs. The infectious matter may likewise be transmitted by means of tumblers, glasses, spoons,,tobacco-pipes,
syringes, surgical instruments, lancets, water-closets, etc.
Prostitutes who do a large business, sometimes communicate
the disease without being themselves affected. The poisonous
matter commingles with the vaginal mucus, without infecting
them, but is transmitted'to the next healthy customer.  By
washing herself, the girl, whose vaginal mucous membrane
had become thick and hardened by excessive use, remains
free from the disease.
The principal forms of the primary syphilitic disease are
the primary ulcer or chancre, and the primarg inflammation
of the lymphatic vessels and glands in the neighborhood of the
chancre.
CHANCRE.
From three to eight days after an impure coit or after contagion has taken place, an itching and slight burning are
experienced at the spot where infection had taken place,
after which a small red spot comes out, upon which a clear
vesicle of the size of a pin's head starts up, whose contents
become turbid and purulent.  This vesicle breaks and gives
place to a small ulcer, with sharp, inverted edges; the opening of the ulcer is narrower than its base. The place where
the ulcer is seated, is somewhat hard and swollen. The pus
is grayish, bloody, and mixed up with remnants of tissue.
Sometimes the patients are not aware of the trouble until
after the disease is completely developed. This is particularly the case with men who have a contracted prepuce, and
still more with women in whom the infection first took place
in the vagina. A chancre may possibly develope itself on any
part of the body; it is most frequently seated under the
glans, by the froenulum, round the corona glandis, on the
inner surface of the prepuce, on the scrotum and at the anus,
less frequently in the urethra. According to Professor Sigmund's statement in the Vienna Mediz. Wochenschrift of the
12th of April, 1853, chancres in thb urethra are not near as




CHANCRES.                      109
uncommon as has been supposed.  Among 483 chancres, 47
were located in the urethra. Chancres are likewise seen on
the lips, tongue, eye-lids, ears and fingers; in the'female, on
the labia, at the entrance of the vagina, in the interior of the
vagina, at the neck of the uterus, anus, less frequently at
the nipples, lips, tongue, or in the buccal cavity.
Taking the physiological and pathological character of the
chancre as a guide, we distinguish the superficial, indurated
and phagedenic primary syphilitic ulcer.
The superficial chancre is confined to the upper layer of
the skin, only a very small portion of its tissue being destroyed,
and the exudation round about being either entirely wanting
or only very trifling.
The indurated or so-called Hunterian chancre penetrates
through the whole thickness of the skin, the loss of substance
is quite considerable, and a quantity of matter is secreted
from the ulcer, which becomes rapidly organized and forms
all around the ulcer a hard node that can be felt with the
finger and constitutes the principal characteristic of this
variety of the disease. It is this variety of chancre which
is always present in constitutional syphilis.
The phagedenic or diphtheritic chancre is principally developed in impoverished individuals who are at the same time
affected with scrofula. The ulcer is covered with a thick
gray layer of false membranes, beneath which the destruction of the tissues in surface and depth goes on quite rapidly;
the margins are thin, violet, brown, shaggy, rolled up; the
secretion is thin, fetid; the cicatrization takes place much more
slowly, sometimes not till the ulcerative process has destroyed
a considerable extent of tissue by suppuration, both on the
surface and in depth; in some cases dangerous hkemorrhage
even takes place.  The phagedenic ulcer is generally very
painful; on the.other hand, the constitutional symptoms are
very rare, because the poison seems to have exhausted its
action by the violence of the local symptoms. Supervening
buboes, if ending in suppuration, are disposed to assume the
same character as the chancre.




110                PRIMARY SYPHILIS.
In some cases the chancre becomes gangrenous.  In such
a case the destruction of the tissues goes on at a rapid rate,
so that the whole glans is sometimes destroyed in a short
period. After the sloughing a simple ulcer remains which is
easily healed.
The treatment must be conformable to the form  of the
ulcer. Whereas a simple chancre is sometimes cured in from
two to three weeks without any signs of constitutional syphilis, the indurated chancre, even under the most careful allopathic treatment, never gets well without symptoms of constitutional syphilis supervening after five or six weeks of treatment.  Under homoeopathic treatment, which may last from
six to eight weeks before a cure is perfected, the constitutional disease is generally prevented. The treatment has
to be continued until every trace of induration has disappeared.  The ulcer frequently heals without the induration
having been entirely removed round the cicatrix; if this is
not accomplished to the last vestige, constitutional syphilis
will pretty certainly develope itself.
The treatment of the phagedenic chancre has likewise to
be continued for some time.
In any variety of chancre the internal treatment has to be
accompanied with the utmost cleanliness. The ulcer should
be kept covered with lint dipped in water, and should be
repeatedly cleansed during the day. A linen rag moistened
with cold water may be placed on the ulcer, and the penis
wrapt up in a linen bandage. Moreover, the penis should be
supported by a suspensory, to prevent the pressure of the
blood, by which the cure would be retarded.
Among the remedies to be employed for the cure of chancre,
I mention particularly Acidum nitricum, the specific effect
of which has scarcely ever disappointed me. I have found
it particularly indicated by the following conditions: chancres
of the orifice of the urethra, prepuce, margin of the prepuce;
chancres with bloody, fetid, ichorous pus; small chancres
without inflamed borders, with flat edges; considerable swelling of the glans, of the meatus urinarius, which are of a




CHANCRES.                     111
dark-red color and puffed up; small vesicles in the meatus, on
the inner surface and margin of the prepuce, which soon
break, suppurate and form chancres; deepulcer at the corona
glandis, with elevated, lead-colored, extremely sensitive edges;
flat little ulcers at the corona glandis, which look clean, but
secrete a strong-smelling matter; itching of the prepuce and
damp places on its inner surface; burning of the inflamed
and swollen prepuce, the inside of which is denuded of the
epidermis and covered with small little ulcers, secreting an
ichor that has a pungent, nauseous odor, and stains the
linen like bloody pus; simple flat chancre in the vagina, it is
covered with yellow pus and burns and itches; and lastly,
inflammation of the vagina and labia majora.
Accordingly, Acidum nitricum will be found particularly
adapted to simple chancre, chancre in the meatus urinarius
and in the vagina.
Arsenicum: Gangrenous ulcers with bloody edges, corrosive pus; ulcers with copious secretion of watery, fetid ichor;
painless ulcers with hard edges; lardaceous, stinging chancrous ulcers with white places in the middle of the ulcer;
Gangrenous chancre on the glans and prepuce; sudden
gangrene of the penis.
Accordingly Arsenicum will be found adapted to phagedenic, gangrenous chancres, and accordingly to the indurated
chancre of Hunter.
Argentum nitricum: Little ulcers on the prepuce, the tips
of which are at first covered with pus, and which gradually
spread in extent and become covered with a tallowy or
lardaceous substance; swelling and knotty hardness of the
urethra, inflammation and pains in the urethra, priapism,
dysuria, hzematuria.  (Chancre in the urethra.)
Aurum muriaticum: Chancres of the scrotum, with fetid,
ichorous pus.
Calcarea carbon: Chancres. on the lower surface of the
penis; chancres with burning pain, having the form  of
rhagades.
Carbo veg.: Readily bleeding chancres with secretion of
ichor.




112                PRIMARY.SYPHILIS.
Causticum: Chancres with acrid, corrosive pus or a watery,
greenish secretion, with jerking pain, developed out of little
blisters, complicated with gout, scurvy and cutaneous eruptions, disposition to fungous formations. (Phagedenic chancre.)
Hepar sulphuris: Readily bleeding chancres with lardaceous edges and fetid secretion.
Iodine: Florid chancres with  raised  edges that are
more or less shaggy, watery secretion.
Mercurius solubilis: Red chancre on the prepuce; spreading and deeply penetrating ulcers on the glans and prepuce;
pale-red vesicles on the glans and prepuce, forming small
ulcers after breaking; readily bleeding chancres; distressingly painful chancres, secreting a quantity of yellowishwhite fetid pus; small, chancres with, a cheesy bottom,
inverted, red edges; inflamed round chancrous ulcers with
swelling of the vagina; chancres with edges resembling raw
flesh; not very painful ulcers, sensitive to the contact of
linen; vesicles at the forepart and on the side of the glans,
spreading and penetrating more and more; ulcers of the
glans and prepuce with cheesy, lardaceous bottom  and hard
edges; a number of small red vesicles at the tip of the glans
behind the prepuce, breaking after a fortnight and forming
little ulcers, which secrete a strong-smelling, yellowish-white
matter that stains the linen; afterwards the larger ulcers
bleed and are painful when touched, from which the whole
body was sympathetically affected; they were round, their
edges looked raw and the bottom  of the ulcers was covered
with a cheesy matter.
Mercurius corrosivus: Chancres with ichor adhering to
the bottom of the ulcer so firmly that it cannot be removed
by washing; ulcers with thin pus, leaving stains upon the
linen as from melted tallow.
Staphysagria: Smarting vesicles on the inside of the labia
majora, painful when touched; chancres with fetid ichor.
Sulphur: Chancres with lardaceous white spots and secretion of fetid ichor; ulcers covered with scurfs, and looking
like itch-sores; chancres on the prepuce, resembling excoria



BUBOES.                      113
tions; superficial chancres as if the skin were excoriated;
red ulcers with lardaceous bottom here and there, lined with
a thin matter that can be easily removed; violently itching
ulcers, impeding one's walk; torpid ulcers complicated with
scrofula, scurvy, gout and cutaneous eruptions.
Thuja: Vesicles on the glans; erosions on the inner surface of the prepuce, which secrete a humor and suppurate;
red spots on the prepuce; granular spots on the outer surface
of the prepuce, which change to ulcers, become covered with
scurfs, itch and burn; pustules on the inside of the prepuce,
depressed in the centre, secreting a humor and suppurating,
painful only when touched.  Burning pain at the corona
glandis: flat, itching ulcers surrounded with redness, with
stinging pain and unclean bottom.  Whitish chancres with
hard edges.  Chancres with shaggy edges and lardaceous
bottom.  Chancres with sharply circumscribed edges, and
clean, flesh-colored bottom. Chancres with thin, fetid ichor.
During the treatment of primary syphilitic ulcers, the
diet should be strictly conformable to the principles of
homoeopathic practice.  Impoverished  individuals afflicted
with phagedenic chancres, have to use a nutritious diet.
Cleanliness is indispensable in every case.
PRIMARY INFLAMMATION OF THE NEIGHBORING GLANDS.
BUBOES.
The inflammation and suppuration of lymphatic glands is
generally the first symptom of the infection of the general
organism by the syphilitic poison. The inguinal glands, with
the surrounding cellular tissue, are generally those that first
become affected, inflamed, indurated and then pass into the
stage of suppuration.  Such swellings are termed buboes.
They generally arise from the contagious pus of the primary
ulcer being absorbed by the lymphatic vessels. One or more,
even f6ur weeks generally elapse before the bubo begins to
develope itself, sometimes after the chancre is healed. Buboes
in the groin occur most frequently when the chancre is seated




114                PRIMARY SYPHILIS.
at the orifice of the urethra or on the frenulum. They likewise accompany chancres seated on the scrotum, external
pudendum, in the vagina, on the neck of the uterus, on the
mons veneris, on the inner and upper surface of the thighs,
on the nates and rectum. Buboes occur rarely in both
groins at the same time; this only takes place when chancres
exist on both sides of the penis.
Primary ulcers of the lower lip and of the tongue give
sometimes rise to buboes under the chin, generally in the
corner of the jaw; chancres on the upper lip give rise to
buboes at the same place, or in front of the ear; chancres of
the wings of the nose and eye-lids, have buboes directly in
front of the meatus auditorius externus, at the place where
the lobule adjoins it, in some cases above the malar bone;
chancres of the nipples give rise to swellings of the axilliary
glands; chancres on the fingers result in glandular swellings
on the inner side of the elbow joint, and in the axilla.
The cause of primary not constitutional buboes is, as we
said before, the absorption of the pus secreted from  the
primary ulcer. Such buboes develope themselves much more
readily and frequently when the primary affection is slight;
the secretion of pus is scanty and the inflammation not very
acute.  The development of the bubo does not depend upon
the size of the chancre.
A  swelling of the inguinal glands maybe induced by
external causes, such as a cold, violent or fatiguing exertions
of the lower extremities during work or by excessive walking,
dancing, etc.  Persons who have to stand a good deal, are
likewise liable to the development of buboes.  They may
likewise arise from an excessive enjoyment of sexual intercourse, from errors in diet. Women are generally less liable
to buboes than men.
If buboes and chancres co-exist, the invasion of constitutional syphilis may be pretty certainly depended upon. This
is probably the reason why buboes are regarded by many
physicians as signs of constitutional syphilis.
We distinguish three forms of the primary bubo, cor



BUBOES.                      115
responding somewhat to the three varieties  of chancre;
acute, inflamed buboes, which generally terminate in suppuration, after which the pus escapes from under the skin;
indolent or indurated buboes running a long course, and
characterized by organized exudations, which do not readily
suppurate, and phagedenic buboes.
These three varieties of buboes only correspond to the three
forms of chancre in so far as this, that they run a similar
course; but they are not necessarily related in this manner
that indurated buboes accompany indurated chancres, or phagedenic buboes phagedenic chancres.  Any variety of bubo
may supervene with any form of chancre.
The acute bubo sets in with symptoms of very violent
inflammation; the pain and the swelling of the glands increase
very rapidly.  The surrounding  cellular tissue becomes
infiltrated with the inflammatory exudation, forming a large
and hard'wall around the immovable gland.  Shortly after,
the skin over the tumour becomes hot, a slight redness
developes itself in the middle, it becomes shining and very
sensitive.  The motion of the lower limb is very painful, and
the patients frequently complain of a tearing and stitching
pain in the whole thigh of the affected side. If the bubo is
not scattered, the suppurative process first developes itself in
the cellular tissue round the gland. The pus which developes
itself round the tumor, gives rise to an oval, soft swelling, in
the centre of the tumour; the gland itself still continues to
remain hard.  Afterwards the suppuration likewise invades
the gland. When the tumour is on the point of breaking the
skin becomes pale, of a bluish-red color.  A violent inflammation of the inguinal glands is sometimes accompanied by
oedema of the labia majora, or in both sexes by oedema of
the abdomen and of the internal surface of the thighs. Generally fever supervenes, the patients complain of pain in the
extremities, coated tongue, full and hard pulse, headache,
thirst, etc. When the pus begins to form, chills seti n. If
the suppuration is completed, the fever abates, the pains grow
less, and the motions of the limb become less painful. The




116                PRIMARY SYPHILIS.
pus escapes in one or more places, generally where the skin
is thinnest, nearest the centre.  The openings have shaggy,
red margins.  The pus 1s of the consistence of cream, and
has a greenish, or dark yellow color.
The indolent bubo appears as frequently after primary,
particularly after indurated chancres, as after constitutional
chancres arising from mucous tubercles (plagues muqueuses).
This bubo runs a characteristically slow course, and does not
begin to grow until the chancre is healed.  This growth
takes place very slowly; the bubo is very little painful, and
feels hard. The skin over the swelling is not altered either
in color or temperature; it is moveable over the rugged
tumour.  When quiet the patients are without pain; it is
only when walking or sitting with the thighs considerably
bent, or when pressing upon the tumour, that a tension and
drawing are experienced. These buboes are much larger
than the former variety, and frequently remain unaltered for
months, especially in the case of men. Signs of an increased
vital action in the tumor develope themselves very slowly.
The skin becomes hot and the patients experience slight
stitches.  iThe suppurative  process, however, only  takes
place in a portion of the glandular tumor.  Small, soft
places corresponding to the single glands, and, with an
indistinct fluctuation, gradually make their appearance; the
skin over these parts is at first of a bright-red color, which
afterwards, but slowly, changes to a blue-red. If the tumor
breaks in such a place, only a small quantity of thin, flocculent pus is discharged.  The opening seldom  increases to
any great extent; it looks like an unequal, corroded ulcer
of the size of a bean, with a dark-yellow, or gray-red rugged
bottom; the skin is undermined much farther, but is thinner
only round the edges; only a small quantity of a thin
yellowish fluid escapes. It scarely ever happens that the
entire glands are changed to pus; at the bottom  of the
ulcer they generally constitute an uneven surface traversed
by ridges. Between and by the side of the glands fistule
with indurated edges develope themselves in various direc



BUBOES.                      117
tions, and frequently lead to the secretion of considerable
quantities of pus.
The phagedenic bubo, as soon as it assumes the condition
of an ulcer, has the same properties in regard to shape,'
spreading  and  healing, as the phagedenic chancre.  It
developes itself just as frequently after indurated chancre, as
in consequence of the simple spread of the disorganizing
phagedenic chancre.  The external and internal causes of
the phagedenic bubo are the same as those of the phagedenic
chancre.  It commences with a violent, erysipelatous inflammation of the skin, which spreads rapidly both in extent and
depth.  The patients complain of violent pain in the tumor,
acute fever, the pulse is small and rapid, thirst intense, tongue
coated, there is restlessness and sleeplessness. The skin over
the tumor soon assumes'a livid or dirty-yellow, brown color,
becomes gangrenous, sloughs, and the phagadenic chancre is
completely developed.
In regard to the syphilitic bubo, we have to observe three
things: 1st, to prevent its development (prophylactic treatment); 2d. Scattering the existing tumor; 3d. Healing of
the ulcer after suppuration has set in and a discharge of pus
has taken place.
The prophylactic treatment implies, 1st, as rapid a cure as
possible of the primary chancre; 2d, prevention of the break
ing out of new chancres in the neighborhood of the former;
3d, perfect rest of the diseased parts.
The two other conditions of the treatment are met by one
or more of the following remedies, which have to be chosen
in accordance with the symptoms: Calcar. carb., Clematis,
Copaiv., Dulcam., Graphites, Kali carb., Lycopod., Mere.
sol., Natr. carbon., Nat. mur., Nitric acid., Nux vom., Phosphor., Phosphoric acid, Pulsatilla, Sulphur, Terebinth.,
Thuja.
(The principal remedies for buboes are: Mercurius sol.,.Kali hydriodicum, Silicea, Calcarea carb., Acidum nitricum,
Graphites, Thuja.
Mercurius sol. may be used as soon as the bubo begins




118             CONSTITUTIONAL SYPHILIS.
to form; if it should not suffice to prevent the development
of the bubo, we may resort to
Kali hydriodicum, which may also be used alternately
with Mercurius.
Calcarea and Graphites are suitable for chronic buboes,
of a torpid character.
Acidum nitricum, if Mercurius had remained ineffectual,
the bubo continues to increase in size, and there is danger of
suppuration setting in.
Thuja may be useful, if the syphilitic symptoms were mixed
up with condylomatous excrescences on the penis or round the
anus.)
This last named remedy is particularly indicated in incipient inflammation of the inguinal glands, characterized by
stitching, drawing and tension in the groin, and slight swelling of the inguinal glands.' For indolent buboes, Acid.
phosphor., Arsen., Con. macul., Ignat. and Sepia have been
found most efficacious.
Constitutional Syphilis.
This disease developes itself sooner or later after the appearance of the chancre and the absorption of the syphilitic poison by the organism.
The first signs of constitutional syphilis generally make
their appearance some six weeks after the first breaking out
of the primary chancre in the shape of syphilitic cutaneous
eruptions which are sometimes accompanied by ulceration of
the tonsils and mucous membrane of the fauces, or even by
syphilitic bone-pains. At a later period ulceration of the
laryngeal and nasal mucous membrane supervene.
After the poison has been absorbed by the constitution, its
contagious properties are gradually diminished and disappear
entirely after the constitutional disease is fully developed.
In general, in proportion as the syphilitic disease penetrates
the organism, its original character frequently becomes altered
to such an extent that it is frequently exceedingly difficult
to diagnose the disease and to distinguish it from  other




CONSTITUTIONAL SYPHILIS.             119
equally penetrating disorganizing diseases, such as scrofulosis,
tuberculosis, etc.
It does not always follow that primary syphilis must necessarily be followed by the constitutional disease. According
to statistical results, among a hundred males affected with
disease, from  25 to 48 become constitutionally diseased;
and among a hundred females, from 45 to 55.  Moreover,
the longer and the more copious the secretion of pus from
the primary chancre, the more certain is the constitutional
disease.
Climate and season have considerable influence on the
development of constitutional syphilis. In the temperate
zone it is a general rule that the syphilitic eruptions are most
frequent during the extremes of temperature, extreme cold
or extreme heat. In the damp and cold season, particularly
in spring and late in the fall, affections of the buccal and
pharyngeal mucous membrane are most frequent.  Cold,
derangements of the cutaneous action, changes of the weather,
damp swellings, etc., favor the development of constitutional
syphilis.  Want or starvation, violent emotions, errors in
diet, irritations of the intestinal mucous membrane by artificial articles of food or drink, abuse of spirits, excessive eating, want of exercise in the open air, fatiguing labor, forced
marches, war, bivouacking, etc., excite the syphilitic dyscrasia.
On the contrary, the constitutional disease can be put off
for a long time by rest, warmth, good clothes, suitable diet.
These circumstances likewise favor the cure of the constitutional malady.
Although constitutional syphilis occurs more frequently
among women than among men, yet it runs a more rapid
course among the former.  Pregnancy has a peculiar effect
upon syphilis.  During pregnancy, and particularly during
the second period, new forms of the disease scarcely ever
make their appearance. Existing forms of the disease either
disappear of themselves or readily yield to treatment. Even
when left to nature, they do not get worse until after partu



120             CONSTITUTIONAL SYPHILIS.
rition. This is particularly applicable as regards affections
of the mucous membranes, skin, bones, glands, etc. Vegetations at the anus or sexual parts generally disappear of themselves towards the end of pregnancy, but exercise a so much
more pernicious influence upon the fetus.
The signs of constitutional syphilis have a peculiar character, and on this account, are justly considered a specific
malady.  For instance, it is characteristic of this disease,
only to affect certain organs, and even parts of organs, principally the mucous membrane of the mouth, fauces, nose,
rectum and sexual organs; the skin and its appendages, the
sub-cutaneous cellular tissue; the lymphatic system; the
muscles and tendons; the brain and its membranes; the
periosteum and the bones; the iris; the testicles and ovaries;
the liver.
The constitutional disease is moreover distinguished by its
form  and color.  The eruptions are generally of a copper
color, rounded, disposed to form arched groups, or simple
arches, rings, or serpentine lines, and giving rise to exudations which dry up and form crusts. Another peculiarity of
the disease is, rarely to affect only one organ or tissue, but
several tissues at the same time.
The skin and mucous membranes, and the lymphatic glands,
are the most frequent seats of the constitutional disease in all
its various forms, degrees and stages.
The development of the constitutional symptoms takes
place in two successive periods, termed by Ricord secondary
and tertiary syphilis.
Although these two forms of the constitutional syphilis
are not separated by any distinct lines of demarcation, yet
this distinction seems to be very convenient, and is very generally recognized by physicians. These two forms sometimes
co-exist at one and the same period.




SECONDARY SYPLlILIS.                 121
Secondary Syphilis.
In some cases, the first signs of constitutional syphilis
appear during the existence of the primary chancre, especially
the Hunterian or indurated form; generally, however, they
break out a few months, and in a few rare cases, several years
after the primary disease.
Careful observation would probably show that the first
absorption of the poison by the general organism is accompanied by a feverish reaction, termed syphilitic eruptive fever.
Afterwards it assumes all sorts of syphilitic inflammations and
ulcerations, growths, indurations, etc.  The mucous membranes are first invaded by these derangements, particularly
the mucous membrane of the mouth, fauces, and the adjoining
parts; afterwards the mucous membranes of the labia pudendi
and vaginae, or the outer skin in the shape of eruptions,
termed syphilides; and finally the eye, especially the iris,
causing iritis syphilitica.
The first development of constitutional syphilis is frequently
announced by paleness of the patient, swelling of the lymphatic glands, especially on the neck, shifting pains of an
apparently rheumatic or neuralgic character, various cutaneous eruptions peculiar to syphilis, falling off of the hair,
iritis and febrile motions.
This peculiar eruptive fever, generally precedes with more
or less distinctness, the appearance of constitutional affections
of the skin and mucous membranes.  The first sign of a
general infection of the organism is a feeling of malaise
throughout the body.  Afterwards, a very violent headache
is experienced, in the forehead, occiput, and sometimes over
the whole head.  The patient complains of an aching, burning, stinging pain, or a pain as if the head were pressed
together with an iron band, or split in two. The pain becomes
more and more intolerable, and a variety of other symptoms
supervenes, such as heaviness and tearing in the shoulders,
forearms, small of the back, legs and knees, excessive languor,
restlessness, sleeplessness, coated tongue, thirst, constipation,.9




122               SECONDARY SYPHILIS.
hot skin which is constantly covered with a little moisture,
quick and rapid pulse; the urine deposits a sediment.  The
cervical glands commence to swell.  The cicatrices of the
primary ulcers become darker, sensitive, they swell and grow
larger and harder. In bed the pains either diminish or disappear altogether, particularly after the appearance of the
constitutional symptoms.  Recently Sigmund observed that
the first appearance of the eruptive fever is frequently
attended with symptoms of jaundice, which seem to be referable to the ulterior development of the liver affection.
I. SYPHILITIC DISEASES OF THE MUCOUS MEMBRANES.
These diseases either appear in the form of erythema and
erosions of the mucous membrane of the mouth, fauces, nasal
cavity and sexual organs, or in the shape of little blotches,
flat tubercles (mucous tubercles) of these membranes, or
finally, as deep-seated tubercles and ulcerous excavations of
the same.
Syphilitic Erythemata  and Erosions of the Mucous
Membranes.
These eruptions occur most frequently on the mucous
membrane of the mouth and fauces.  They constitute isolated, circumscribed, dark-red or copper-colored, not very
elevated, inflamed spots or streaks on the mucous membrane, especially on that of the soft palate, tonsils, uvula,
pharynx and larynx.  The buccal cavity and the fauces
become hot, a difficulty of swallowing and a burning sensation in the fauces; hoarseness and pain when talking are
experienced, the patient coughs and hawks, the voice becomes
snuffling or jarring, the mouth and throat feel dry. The
inner surface of the lips'and cheeks, the palate, tonsils, uvula,
the posterior surface of the pharynx, look bluish-red, the
follicles are swollen and engorged with blood. In the centre
of the intensely-red spots we discover smaller insulated spots
of a grayish-white color, which, upon close examination, are
found to be erosions.




SYPHILITIC ERYTHEMATA.                123
Similar derangements are perceived on the mucous membrane of the nasal cavity and of the sexual organs. The nose
seems at first affected as in common catarrh, but the symptoms are really precursors of mucous tubercles, or the so
called plaques muqueuses. On the internal layer of the prepuce, in the furrow behind the glans and round the meatus
urinarius, these tubercles generally form small rounded erosions upon a bright copper-colored base, and flat marginl.
gradually disappearing in the surrounding membrane, and.
secreting a grayish, purulent, fetid fluid. Similar phenomena
are seen on the mucous membranes of the pudendum.  In
both sexes these erosions give rise to the formation of condylomata.  At the anus, rhagades with a lardaceous bottom
frequently develope themselves.
Among the remedies which are particularly adapted to this
form of the syphilitic disease, the following are to be noticed:
Aconite, (also during the eruptive fever,) Anacardium, Arsen.,
Bellad., Aurum  mur., Bryon., Calcarea carbon., Cannab.,
Canthar., Copaiv., Crot., Mercur. sol., lflercur. corros., Natrum
carbon., Nitri. acid, Nux vom., Pulsat., Sulphur, Thuja.
Recently I have used Anthrakokali with advantage.
[Acidum nitricum is an excellent medicine in this affection,
especially if the spots are dark-colored and disposed to bleed.
Mercurius sol. and corros., more particularly if no mercurial preparations had as yet been employed.
Aurum  mur., if the syphilitic disease is complicated with
symptoms of mercurial poisoning, in which case,
Sulphur may likewise prove serviceable, also Hepar sulphuris.
Arsenic will help, if gangrenous symptoms set in, or badlooking scurfs cover the spots.
Kali hydriodicum is a most useful agent if the eruption
shows a tendency to ulceration.]




124               SECONDARY SYPHILIS.
Mucous Tubercles, Plaques Muqueuses.
These occur most frequently in females and children; in
men they are less frequently noticed on the sexual organs
and at the anus; in both sexes they develope themselves most
frequently on the mucous membranes of the mouth and fauces.
These mucous tubercles being still possessed of contagious
properties and capable of developing by their secretion chancrous ulcers, they were for a long time looked upon as symptoms of primary syphilis.
They consist in flat, circumscribed elevations of the mucous
membrane, which, together with its follicles and the submucous cellular tissue, is engorged and thickened, and
secretes a tenacious, purulent exudation of a peculiar and
extremely offensive odor.  Their size varies from that of a
millet-seed to the size of a dime. Sometimes several of them
unite, forming irregularly-shaped, vaulted flakes. The smaller
ones have altogether a tuberculoid shape, are generally very
humid, regularly rounded, forming truncated' cones, of a
brighter redness in the centre than at the margin, and frequently are united in groups or regularly-shaped rings,
especially on the glans, the inner surface of the cheeks and
lips, the curtain of the palate, tongue, and at the roof of the
mouth.  The surrounding parts have a bluish-red, or bright
copper-color.
The large tubercles are raised about a line above the
mucous membrane, and either constitute perfectly round or
more or less regularly oval, fall, tense, and, on their upper
surface, flattened elevations of the mucous membrane. Their
color is a bright-red. On their surface they are covered with
a thick, grayish-white layer of epithelium.
As w6 stated above, the mucous tubercles are rarely seen
on the sexual organs of the male, and generally only singly
or in ring-shaped groups. They appear much more frequently
on the female parts, the labia majora and minora, at the
entrance of the vagina, on the upper portion of the interior
vagina, and even on the vaginal portion of the uterus. At




MUCOUS TUBERCLES.                  125
the outer pudendum they occur either isolatedly or in crowds.
Flat tubercles are likewise seen very frequently at the anus,
even in children who had been abused for nefarious purposes.
The most destructive action of these tubercles takes place
in the Schneiderian membrane.   On account of the itching
which they cause in this part, the crusts are scratched off,
which gives rise to more obstinate ulcerations than in any
other part.  In many cases a portion of the wings of the
nose is destroyed, which leaves a rugged surface and the
Schneiderian membrane exposed.
If mucous tubercles develope themselves in the interior of
the nose, the first symptoms are those of a catarrh which,
however, last much longer than usual.  A  tickling and
burning in the nose are experienced, and a watery fluid is
secreted in great quantity; gradually a sensation supervenes
as though it were difficult for the air to pass through the
nose. The patients fancy the nose is full of mucus, and they
blow  it quite frequently.  The whole mucous membrane
becomes red, the faculty of smell is either diminished or
arrested.  Soon the tubercles ulcerate and become covered
with a hard crust of irregular shape, varied thickness,
reddish-brown color, and consisting of dried nasal mucus,
blood and disorganized exudations.  If proper means are not
speedily and vigorously brought to bear upon this affection,
the ulcers increase in size, grow larger and deeper, destroy
the mucous membrane and the subjacent cellular tissue, perforate the septum and cause caries or necrosis of the nasal
bones, cartilages, cribriform plate, etc. A quantity of fetid,
greenish, bloody pus is discharged from the nose, (ozsena
syphilitica;) the cartilages, upper jaw, vomer and t-ie inner
parts of the nose bec6me invaded, disorganised, ihe hard
palate is perforated, the nose disfigured, the speech becomes
indistinct.   The destructive process which is going on in
these spongy bones, may extend to other parts of the head
and vertebrae, and life may become endangered.
The following remedies have been found particularly useful
for this affection:



126               SECONDARY SYPHILIS.
Acid nitricum, Argent. nitr., Bryon., Calcar., Ignat., Pulsat., Rhus tox., Thuja.  If the tubercles are seated in the
nose, the following medicines will be found most efficacious:Acidum nitr., Acid. phosphor., Argent. nitr., Calcar. carb.,
Kali carb., Kreasot., Lycop., Mercur. corros., Pulsat., Rhustox., Sepia, Staphys., Sassapar., Thuja.
[Among these remedies the most important are undoubtedly
the mercurial preparations, and if mercury had been used
previously, and the symptoms are complicated with symptoms
of mercurial poisoning, we may resort to Acidum nitricum,
Aurum muriaticum, Kali hydriodicum and Sepia, in the
order in which these remedies are here mentioned.]
Deep-seated tubercles and ulcerous excavations of the mucous
membranes.
These ulcerations are almost always preceded by a tuberculous thickening of the mucous membrane and the submucous cellular tissue.  The ulcers always penetrate to a considerable depth, destroy the mucous membrane throughout
with great rapidity, and sometimes invade even the subjacent
tissues. The ulcers are either isolated or in groups, rounded,
and have sharply circumscribed, unequal, vaulted, pad shaped,
and sometimes undermined margins.  The bottom of the
ulcers is frequently dotted with granulations, and like the
margins, covered with a grayish or yellow, creamy, papescent,
thick exudation.
These ulcerations occur principally in the neighborhood of
the froenulum and on both sides of the glans.  They may
perforate the lower wall of the urethra, causing urinary fistulae ard strictures.  At the female pudendum  they are
geniTrll"J eated at the entrance of the vagina, the lower
commAissre, in the rugme of the vagina, and on the vaginal
portion of the uterus.  On these parts they are apt to form
abscesses which, if neglected, perforate the whole thickness of
the vagina, spreading to the rectum and urethra, and causing
recto-vaginal or urethro-vaginal fistulae.
These ulcers occur moreover on the gums, in the nose, on




SYPHILIDES.                     127
the tonsils, at the curtain of the palate, on the posterior wall
of the fauces, at the epiglottis and in the larynx, causing
more or less extensive disorganizations in these parts, and
frequently terminating fatally.
The remedies which have been mentioned above for other
forms of secondary syphilis, will, especially at the commencement, be found useful in this disease, if chosen with reference
to the symptoms.
If the destructive process should have invaded the fauces
and larynx, we may add the following remedies to the above
mentioned list:-Arsenic., Carbo veg., Natrumn   ur., and
Zinc. oxydo
II.  SYPHILITIC  EXANTHEMIS, SYPHILIDES, EXANTHEMATA
SYPHILITICA.
The skin being a favorite seat of constitutional syphilis, it
is not to be wondered that it should develope upon this organ
a series of diversified morbid processes and eruptions which,
for convenience of treatment, require to be distinguished into
particular classes.  We shall adopt the  classification  of
the distinguished dermatologist Hebra, which, resting upon a
pathologico-anatomical basis, is on this account to be considered the most expedient and useful.
Syphilitic eruptions have the general features of all other
exanthems, but they occur principally in the shape of spots,
pimples, tubercles, and fig warts. Sometimes they bear a
striking resemblance to particular eruptions, such as measles,
rubeolae, varicellie, lichen, psoriasis, variola, etc.  In this
case they may be distinguished by the following signs from
similar non-syphilitic diseases: The syphilides run a characteristically slow but uninterrupted course which nothing can
arrest.  In most cases they come out in a definite number of
efflorescences, and this number remains unchanged in their
ulterior developments.  Subsequent efflorescences appear at
the same places where the former ones had dried  up.
Syphiloid eruptions are liable to relapses, but they always
reappear at the same places.  Their color is brown-red,




128                 SECONDARY  SYPHILIS.
resembling  the  color of copper or raw  ham.  Professor
Hebra does not look upon this brown color as a characteristic
sign of syphiloid eruptions. According to his opinion, this
brown color arises from  the frequent recurrence of these
effloresences at the same places and the depositions of pigment
which  always accompany the eruptions.  From  a similar
cause, other non-syphilitic eruptions might exhibit a similar
color, and this is indeed the case.  The color of syphilides
need not always be brown-red; if the pigment is yellow, the
color of the eruption may be a mixture of yellow and red.
It is a certain fact, however, that the color of syphiloid eruptions is always characterised by a sickly or dubious appearance, a sort of morbid discoloration.  The color alone would
not be a safe guide of diagnosis, but in conjunction with the
other signs, it becomes an important symptom.
In regard to form, syphiloid eruptions prefer a circular
shape.  In the case of ulcerated eruptions of this class, the
circular form is truly characteristic; first, they are kidneyshaped, and gradually assume a semi-lunar, and finally a
semi-circular form.
Another peculiarity  of syphilitic  cutaneous diseases is
this, that they form  crusts in preference to  scales.  Such
scales are generally thinner and drier than in non-syphilitic
diseases.  The crusts, on the contrary, are generally thick,
large and deeply penetrating, and closely adhering to the
subjacent parts. New crusts continuing to be added from day
to day to the former layer, they gradually acquire an extraordinary thickness as in rupia.  Syphiloid eruptions prefer
such parts of the skin as are without adipose tissue, such as
the head, forehead, (corona venerea,) occiput, nose, tibia; as
a general rule they develope themselves on parts where other
non-syphilitic eruptions are scarcely ever noticed.  They
become visible in the cold, and disappear during the warmth,
particularly the roseola syphilitica.  This is the contrary
with non-syphilitic eruptions, which generally come out in
warmth and disappear in the cold. Syphiloid eruptions do not
itch; this is another of their peculiar characteristics, and




MACULAX.                      129
reveals the syphilitic character of many eruptions which
might otherwise pass for non-syphilitic. These eruptions
constitute the first series of secundary syphilitic symptoms,
and are sometimes accompanied by ulceration of the tonsils
and pharyngeal mucous membrane, and in a few cases by bonepains. Afterwards ulcerations of the laryngeal and nasal
mucous membranes supervene.
As regards the classification of syphilides, the former method
of arranging them under distinct heads with reference to their
original or typical forms, is exceedingly inconvenient and
impracticable; for these forms generally run into one another,
and it frequently happens that several of them co-exist.
Hebra views the various forms of syphilides as certain stages
of the syphilitic disease. upon the skin; generally ilt first
appears in the shape of spots; afterwards it assumes the
tuberculoid, then the squamous, fymatous, and other forms.
According to Hebra, there are four or five positive periods
during which the various forms of the syphiloid cutaneous
disease gradually develope themselves.
Consequently we divide syphilides into
Erythemata (maculw, syphilis cutanea maculosa;
Syphilis cutanea nodosa;
Syphilis cutanea squamosa, psoriasis;
Syph. cutan. papulosa;
Syphil. pustulosa, vesicles, blisters pustules;
Rupia syphilitica, crusts;
Condylomata;
Syphilitic affections of the hair and nails;
2acule, spots, ephelides.
This form is the most frequent and comes out'f,    The
spots are separate, bright red, sonmetimes, however, they are
very pale and only come out in the cold. Sometimes they
are raised like blotches. Most ordinarily they appear on the
chest, neck, face, arms, and in some cases on the inner side
of the thighs, and in the neighborhood of the sexual organs;




130               SECONDARY SYPHILIS.
other parts of the body are likewise liable to becoming the
seats of these spots.
Not unfrequently they are accompanied by difficulty of
swallowing, burning and dryness of the throat. They are
distinguished from non-syphilitic spots, such as measles or
rubeolae, by this, that these non-syphilitic eruptions never
become chronic, and generally disappear again after a period
of from four to eight days. If the eruptions last longer, we
may safely look upon them as syphilitic, roseola syphilitica.
This eruption runs a slow course, it is true, but never of
five or six months; for previous to this it takes the form of
tuberculoid syphilis. At certain periods, after eating, for
instance, the spots grow larger. After having stood for some
time, they generally grow paler, and the red color usually
assumes a dirty gray, or gray-red tint.
Syphilitic cutaneous tubercles, flat tubercles or condylomata.
These tubercles are.either single and incoherent, or else
they form circular lines, or finally, they appear in groups or
clusters.  Very frequently they appear in company with
mucous tubercles, principally on the scrotum, penis, mons
veneris, in the inguinal folds, on the perineum, round the
anus, on the inside of the thighs, on the nape ef the neck, in
the axillae, on the hairy scalp, in the face, round the mouth,
on the wings of the nose, on the forehead, between the toes,
and along the nails.  As a general rule, they only come out
in one or the other of these places, only in a very few cases
over the whole body. I have only seen one case of this kind,
at Professor Hebra's clinique for cutaneous diseases.
The secretion which is discharged by these tubercles, continues in most cases contagious, not only for others, but also
for the adjoining portions of the skin and mucous membrane
of the patient himself. Generally they are of a bright copperred color, and almost always painless. They develope'themselves slowly and remain unaltered for along time.  Not
unfrequently an ulcer forms on the surface of the tubercle,
which becomes covered with a hard crust that leaves a deep




SQUAMAE.-LICHEN.                    1 31
cicatrix after falling off. If the tubercles do not ulcerate,
they usually become depressed and flat, and assume a scaly
form.
Squamous syphilis, scales, psoriasis.
Generally, this form arises from the tuberculoid form, and
sometimes from  the spots.  The tubercles pass into large,
irregularly-shaped, and sometimes confluent elevations of a
bright copper color; they are covered with hard, readilytearing scales, of a dull white color. As the disease progresses, the eruption loses its bright color, and only the scales
remain.  This usually takes place in the face, in the hollow
of the hand (psoriasis palmaris), and on the soles of the feet
(psoriasis plantaris.)  In the palm of thy hand the patient
first sees brown-red spots; after a while, while washing himself, the patient imagines he observes callous risings above
these spots. These risings are scratched off by the patient;
they come off in the shape of scales, after a while the livid
spots and risings return, are scratched off a second time, after
which rhagades and then ulcers form. Ulcers are very apt
to arise from any form of syphilitic efflorescences.
Papule, lichen.
We distinguish large and small papulae.  The small papulae
constitute miliary, acuminated, hard elevations on the skin,
which are disposed to pass into suppuration or to assume
the form  of acne syplilitica.  These papule generally form
round, circular or arched groups of a bright-red copper color,
and frequently come out in innumerable quantity.  The eruption of the papulae is almost always preceded by fever.  Th.e
exanthem may develope itself on every part of the body, but
it appears most frequently on the extremities, back, nape of
the neck, shoulders, on the parts adjoining the sexual parts,
and on the lower surface of the penis, less frequently in the
face and on the neck.
The large papulae appear most frequently on the extremities, shoulders, nape of the neck, chest, forehead and hairy




132                SECONDARY SYPHILIS.
scalp; sometimes on all these parts at one and the same
period. Generally it remains unaltered for several months.
Unless arrested by proper treatment, the eruption  keeps
renewing itself constantly. Previous to the appearance of
the papulae, small, reddish-yellow spots of a regularly round
shape appear upon the skin, either singly, scattered over a
large space, or, more rarely in clusters. Upon these spots
start up slowly and in a perpendicular direction, acuminated,
hard, globular, lenticular callosities, from one to two lines in
diameter, and of a bright copper color. Soon they reach the
size of a pea, and are so closely crowded together that the
place where they are located constitutes an elevation upon
the skin.  In some cases they constitute rings of various
sizes raised above the skin, and generally of a rounded shape.
The open sides of the adjoining rings are sometimes in opposite directions, so that, if the terminal points of the lines communicate, a serpentine or wave-line is formed. Sometimes
the papulae form scales, under which ulcers are seldom witnessed.
The large papulae are frequently accompanied by ulcers in
the fauces, inflammation of the iris, papulous eruptions on the
mucous membranes of the sexual organs, especially the mucous
membrane of the glans.
Syphilitic pustules, vesicles, blisters, bulloe.
Syphilitic vesicles are an extremely rare disease; among
1000 cases scarcely one occurs.  Prof. Hebra who is at the
head of one of the most extensive cliniques of Europe for
cutaneous diseases, has never yet seen such a case.  This
impartial observer maintains that herpes is neverof syphilitic
origin; a syphilitic eczema would not cause any itching,
and would gradually terminate in ulceration; but every
eczema does cause an itching, hence it cannot be syphilitic.
At all events the existence of this form is doubtful.
This remark does not apply to the other syphilides with
liquid exudations, such as syphilitic pustules, bullae, blisters,
pemphigus, ecthyma and impetigo pustulo-crustacea.




BULLE,.                      133
Syphilitic pustules take the form of acne syphilitica in
young, robust, plethoric persons, while the parts surrounding
the pustules are of an intensely bright-red color, and the
secretion of pus takes place more rapidly. The larger pustules, with a pit in the centre, marked by a small, black, drying-up point, can scarcely be distinguished from variola, and
are on this account termed variola syphilitica. In children
who were infected by their nurses, they came out in the face,
on the abdomen and thighs, in the shape of a superficial
ecthyma.  They soon break in these cases, forming brightyellow loosely adhering crusts. In old or young impoverished
constitutions the pustules develope themselves very slowly,
every single pustule being surrounded by a light blue-red,
livid tint.
Syphilitic pustules are very apt to occur after other syphilides, such as papulee or tubercles.
Syphilitic variola is distinguished from genuine variola by
this, that the former keeps breaking out anew in successive
intervals; that the crusts do not fall off at one and the same
period, and that this process lasts longer than in common
variola. Except this, the pustules have the same shape and
size, and cover the same parts of the body, as the common
variola.  They break out and run their course without any
fever.  In some cases, however, the pustules are so large
that they cannot be mistaken for small-pox.
Syphilitic varicella appears mos't frequently in the face,
on the abdomen, on the inner side of the thighs, and on the
legs, less frequently on the arms. This eruption is generally
preceded by a violent fever, on which account it might
readily be confounded with varicella. After the fever has
lasted two or three days, spots break out on several parts of
the body in succession; they are round, of a pale-red, seldom
of a bright-copper color, and soon are raised above the skin
throughout their whole extent, and, in their interior, contain
a bright-yellow of whitish fluid.'Afterwards a copper-colored
circular areola forms around the pustules.
The syphilitic pemphigus is generally noticed in children,




134               SECONDARY SYPHILIS.
less frequently in full-grown persons. It is composed of blisters of the size of beans, and of an irregular shape.  These
blisters generally break, leaving ulcers which, by the matter
which continues to exude, and by a want of cleanliness, form
crusts that frequently increase to an enormous size and constitute the rupia syphilitica.  It is not necessarily the case,
however, for every rupia to be preceded by pemphigus.
The rupia may come on after any syphilitic ulcer.  According to Hebra, the pemphigus of new-born infants is not
necessarily syphilitic.  He maintains that pemphigus is a
disease sui generis, that it breaks out in other parts than
those which are generally selected by the syphilitic disease,
and that it attacks mostly small children who die from  its
effects.  Successive breakings out do not take place in the
case of pemphigus; in some cases ulcers appear after the
blisters, in other cases they are wanting. The pemphigus
of new-born infants always contains gaelic acid according to
Dr. Schottin; that of full-grown persons never contains any.
Pemphigus is generally seated on the sexual organs, on
the abdomen and extremities, less frequently in the palms of
the hands and on the soles of the feet.  It breaks out in
superficial, bloch-shaped risings of the skin, of a bright copper color; the blisters are surrounded by a copper-colored
or violet areola, and always leave yellow, transparent crusts
behind.
The next variety, impetigo pustulo-crustacea, is frequently
seen accompanied with affections of the mucous membrane of
the nose and mouth.  The pustules are crowded together in
large numbers, and run into one another.  Thick, large
crusts form, with ulcers underneath that secrete a tolerably
large quantity of pus, and leave large scattered cicatrices.
They mostly appear on the chest, neck, in the face, at the
eyebrows and on the forehead.  The pustules are preceded
by a more or less bright redness; after a while small,
rounded, purulent tips become visible in close proximity to
each other and running into each other the more rapidly the
more the skin is inflamed.  The pustules which are filled




IIUPIA.                     135
with the purulent secretion, soon break, the discharged pus
dries up to one or more greenish crusts of large size, thick,
not much raised above the skin, surrounded by a coppercolored areola and yielding to the pressure of the finger.
The ecthyma is characterised by larger pustules than the
former. The pustules are circular, conical, from three to four
lines in diameter, and containing a thick, green-yellow pus.
The areola which surrounds the pustules, is of a striking
copper-color, but not very hard. The pustules soon break,
and become covered with a brown, rounded, loosely-adhering
crust of uniform thickness, under which a superficial ulcer is
seated.  The ecthyma is mostly found on the hairy scalp, on
the parts round the mouth and on the forearms, but it may
likewise break out on any other part of the body, and spread
over a considerable extent of surface. If the ecthymatous
pustules are very large, oval, they form a transition link with
the next following eruption, rupia syphilitica.
Rupia Syphilitica.
The rupia frequently arises from pemphigus or ecthyma,
but it may likewise break out without any of these forms
preceding it.  In the former case it arises from blisters of a
regularly round shape, of the size of beans, not very tense,
and surrounded by a copper-colored areola; they stand upon
a swollen, indurated basis, and contain a dark-yellow, purulent fluid, which changes to a brownish color. The pus dries
up in the middle of the blister, and forms a small brown crust.
Round the crust the epidermis likewise rises in blisters filled
with a similar brownish-red, purulent fluid; these likewise
dry up, thus enlarging the crust in extent, whilst its enlargement in depth is promoted by the drying up of the recent
exudations in the interior of the pustules; by this means the
crust gradually acquires a conical or pyramidal shape. The
crusts sometimes increase to an extraordinary size, but they
are not very numerous; there are at most from twelve to
twenty crusts scattered over the whole body.  They run a
very slow course, and, on account of the secretion of pus




136                SECONDARY  SYPHILIS.
which is continually going on under the crusts, undermine
the patient's constitution, so that, after a while, the patients
grow so feeble, that they are scarcely able to walk, the digestive functions are impaired, and a supervening diarrhoea
hastens the final dissolution of the patient.
The serpiginous and perforating tubercles are related to
this form of syphilides. Either of the former eruptions is
greatly disposed to destroy the tissue of the skin. Either
commences with nodous swellings extending into the subcutaneous cellular tissue.  The serpiginous tubercles are
large, hard, and have a pretty regular, round shape. Perforating tubercles only exist in small number, forming spheroidal risings on the skin, and penetrating to the sub-cutaneous
cellular tissue, where they can be felt with the finger as hard
tumors.
Serpiginous tubercles occur most frequently in the face, on
the nape of the neck, on the head, forehead, shoulders and
trunk, less frequently on the rest of the body, but never on
the borders or soles of the feet. By successive growth they
may gradually spread over a large portion of the surface of
a part or of one side of the trunk.  Serpiginous tubercles
have at first a bright copper-color and a shining surface,
which is never covered with scales. Afterwards they become
inflamed, ulcers form at their tips and become covered with
a thick, hard, conical, brownish or yellowish-gray, firmlyadhering crust. If the crust is detached, we discover a superficial ulcer with a grayish bottom, which is speedily covered
with a new, softer, and less dark-colored crust.
The perforating tubercles occur most frequently in scrofulous individuals with a delicate, white skin, generally in the
face, on the cheeks, round the nose and lips, in front of the
ear, on the legs, and also on other parts of the body.
Both these forms of tubercles are greatly disposed to passing
into the form of ulcers; those arising from perforating tubercles frequently destroy the skin entirely.
In few cases the perforating tubercles appear on the nasal
wings and lips in groups of several crowded together; this




CONDYLOMATA.                    137
causes the surrounding parts to swell, and imparts to the
ulcer the appearance of lupus or cancer, with which they are
frequently confounded.  These two eruptions are the most
dilatory in breaking out after the primary syphilis; sometimes six, eight, ten and more years elapse before they make
their appearance.
Condylomata syphilizica, papules muqueuses, (Ricord,) tubercules syphilitiques plates, (Rayed,) pustules plates, (Cullerier,) figwarts.
The original nature of condylomata is not yet settled to
the satisfaction of all parties.   Some consider them  of
syphilitic origin, whereas others maintain that they may exist
without any syphilitic taint.  This is likewise our opinion;
we have seen a number of condylomata which were evidently
non-syphilitic, inasmuch as not a trace of either primary or
secondary syphilis was perceptible in the organism.
The condylomata are either raised and acuminated, or
broad and fiat; they always arise from morbidly enlarged
papillae of the corion, which are covered with a thickened
epidermis.
We generally distinguish two kinds of figwarts, according
as they are seated upon a broad or narrow basis. The broad
condylomata are of syphilitic origin, the acuminated condylomata are non-syphilitic, and may be caused by the irritating
action of coit, by want of cleanliness, gonorrhoea or leucorrhoea, they are generally more obstinate than those with a
broad base.  Some maintain that the broad condylomata are
hypertrophied conditions of the skin, and that the acuminated
condylomata are parasites.
Fricke and Hauck adopt another class of condylomata, the
subcutaneous, consisting of condylomatous swellings in the
mucous and cuticular follicles. Hauck says in this respect:
"In young individuals with a delicate skin, especially in
young females who had been affected with gonorrhoea, leucor10




138                 SECONDARY SYPHILIS.
rhoea, or with acuminated condylomata, but not merely with
chancre, we frequently notice on the internal surface of the
thighs down to the knees, on the outer skin of the penis and
of the labia majora, on the mons veneris and on the abdomen,
but no where else, small, rather hard and elastic, yellowishwhite elevations, of the size of q millet-seed, and about two
lines in height, somewhat smaller at the upper extremity which
is flat, and upon which a dark, dot-shapefd depression is visible. On account of their external appearance, these tubercles were termed by Fricke syphilitic porcelain tubercles.
Hauck discovered the real nature of the subcutaneous
figwarts by the following experiment: Placing both thumbnails against the base of the cutaneous elevation, he pressed
them  together from  above  downwards, upon  which  the
thickened and whitish sebaceous contents started in vermicular shape out of the opened follicle. Upon renewing the
pressure the small follicle was again opened, a small, whitish,
globular, compressed, crisp, sometimes pluri-lobular growth,
started out of the interior, which was at once recognized as
an acuminated condyloma, adhering by its root to the bottom of the follicle, but being otherwise perfectly disconnected
from the surrounding parts.
According to Barensprung, Simon, Kraemer and others,
condylomata constitute a degeneration of single portions of
the skin, particularly of the epidermis, the papillae and the
hairy follicles.  Upon some circumscribed spot the papillae
first grow uniformly larger, and the epidermis covering this
part grows thicker, so that the original condyloma constitutes a flat and smooth elevation upon the skin. On portions
of the skin which are more remote from the mucous membranes, particularly on the scrotum, the condylomata seldom
advance beyond this stage; but on parts which are nearer to
the mucous membrane, the development of the condylomata
takes place much more rapidly.   Towards the end the elongated papilla forms bulbous swellings; these give out shoots,
which in their turn give out other shoots, and in this way a
papillae which was simple atits base, is gradually transformed




CONDYLOMATA.                   189
into a tissue of numerous ramifications. Every papillae contains a blood vessel.
The more extensive these condylomata become, the thinner
becomes the epidermis, which, however, never disappears
entirely. In most cases the epidermis which is thoroughly
pervaded by fluid, resembles the epithelium of the mucous
membranes.
The variety of the forms depends upon the shape and the extent of that portion of the skin which was originally diseased.
If this portion is small, acuminated, and if large, broad condylomata arise from it. At other times the variety of the forms
depends upon the manner in which the ramifications shoot
up, and upon the locality.  If these ramifications shoot out
longitudinally, in this case the condyloma takes the form
of a cone, standing upon its pointed extremity; if they are
developed in every direction indiscriminately, the condylomata assume the shape of raspberries; at the anus the condylomatous growths like to accommodate themselves to the
natural folds of the skin, and being flattened on either side,
they assume the shape of a cock's comb.  If these growths
spread over a large surface in every direction, they form
cauliflower-shaped, pedunculated,  fig-shaped,  mulberryshaped, fungous, grape-shaped, or other kinds of condylomatous excrescences.
Condylomata, whether syphilitic or non-syphilitic, most
frequently attack persons who do not keep themselves clean,
on parts of the skin or mucous membranes, where two flat
surfaces from which corrosive secretions ooze out, come in
contact with, or rub against each other.  They occur more
frequently on the female than on the male parts. We see
them on the labia majora and minora, at the entrance of the
vagina, in the vagina, in the rugoe of the vaginal mucous
membrane, at the roof of the vagina, etc. There are cases
where the whole vagina is dotted with such comdylomata. In
the male sex we see them in the furrow behind the corona
glandis, on the glans, in the meatus urinarius,  Favorite
localities of the condylomata, in both sexes, are the inner
i




140                 SECONDARY  SYPHILIS.
surface of the anus and the surrounding parts, and the
perinaeum; here too they are more frequently in females than
in males. They are likewise observed in the corners of the
mouth and lips, in the nose, mouth and fauces, in the external
meatus auditorius, on the conjunctiva of the eye, upon the
skin of the inner side of the thighs, in the inguinal folds, in
the axilla, and even, though rarely, on the fingers.
Syphilitic affections of the hair and nails.  Alopecia
syphilitica and onyczica maligna syphilitica.
General or partial falling off of the hair, especially on the
head, with furfuraceous  desquamation, occurs in  various
periods of constitutional syphilis, but most frequently as a
consequence of syphiloid eruptions.  At first the hair comes
out more abundantly only when combing it; afterwards the
hair not only comes out on the head, but also at the eyebrows,
eyelashes, whiskers and the sexual parts. The skin on these
parts is covered with thin, whitish or bright-yellow scales,
which constantly form anew.  The whole affected portion of
the skin looks redder. The hair which grows out in the place
of that which had fallen off, is thinner, of a lighter color, it
remains small and frizzles. In young persons it acquires again
its former consistence and rich growth as soon as the constitutional disease is healed. In old persons it remains thin and
small as long as they live. The falling off of the hair is
promoted by the use of mercury.
While the syphilitic diseases is running into the tertiary
form, the onychia syphilitica is frequently added to the other
symptoms.  It is especially the nodous form  of cutaneous
syphilis that is disposed to invade the nails. The patients
experience pains in the fingers, especially in the thumb; the
least pressure is intolerable. Afterwards a small, semilunar
ulcer forms with its convex surface turned upwards; the pain
and sensitiveness become exceedingly acute, the ulcer enlarges
in size, the whole root of the nail is affected and the nail is
finally destroyed without ever growing again.
Onychia syphilitica invades the fingers as well as the toes,




ALOPECIA.-ONYCHIA.                  141
but principally the latter. In most cases several nails are
diseased; it has happened that every nail of the upper and
lower extremities was destroyed.
In conducting the treatment of any of these secundary
eruptions of the syphilitic disease, the diet should be constantly in accordance with the strictest homoeopathic treatment.  What is of still more importance than the diet is this,
that the patient should be kept in an uniform, somewhat
elevated temperature. In the warmer climate of the South,
syphiloid eruptions run a much more rapid and more favorable course, and the cure is much more readily accomplished
than in the colder North.
Among the remedies which we shall mention for the
syphilitic dyscrasia, one or more, in alternation or succession,
will have to be prescribed in accordance with the symptoms.
We have to remember that the syphilides are disposed to pass
from one into another, and that several forms frequently coexist. The proper mode of alternating the drugs, their succession or the.repetition of the dose, will have to be left to
the discretion of the practitioner or the intelligent layman.
In erythema, roseola syphilitica, the following remedies
will be found most suitable: ANTIM. CRUD., Arnic., Arsen.,
Aurum, Bellad., Calc. carb., CANTHARIS., Chelid., Chin.
sulph., Clemat., Coccul., COPAIV., Crot tigl., Lycop., MERC.
SOL., MERC. CORROS., Mezereum, Petrol., Phosphor., TART.
EMET.
In nodous syphilis, flat condylomata, we may use: Antim.
crud., AURUM, Bovista, Carbo anim., Carbo veget., Caustic.,
Hrepar su2ph., Kali carb., Ledum, MER. SOL., Nitr., STAPHY.,
Thuja.
For psoriasis syphilitica we recommend: Baryt. mur.,
Copaiva, Cuprum, Calc. carb., Cale. acet., HEPAR SULPH.,
Kali carb., Mezer., MERCUR., Natr. carb. NITR. ACID.,
Plumbnum, Graph., Gratiola.  (Also, KALI HYDRIODICUM.)
In papulous syphilis we use with advantage: Agaric, Ammon. mur., Arsen., Aurum, Bovist, Caustic., Con., COPAIV.,
Graphit., lod., Kali. carb., KALI HYDRIOD., Ledum., Lycop.,




142                 SECONDARY SYPHILIS.
MIERC., Nat. carb., Nat. mur., Phosphor., Rhus. tox., Stramon., fTabac., Tereb., ZINCUM.
In pustulous syphilis, variola syphilitica, ecthyma syphiliticum, we have: Acid. nitr., ANTIM. CRUD., Amm. mur.,
Argent. nitr., Arsen., Bellad., Baryt. carb., Bryon., Caustic.,
Gale. carb., CANTHAR., Carbo. veg., Clemat., Coccul., Copaiv.,
Crot., Dros., -Evonyn., Graph., Hyos., Kali hydriod., Kali
carb., MERC SOL., MERC. CORROSIVUS, Mezer., Natr. mur.,
Phosphor., Petrol., Ranunc. bulb., Ranunc. sceler., Rhus.
tox., SASSAPAR., Secale corn., Tabac., Tereb.
For rupia syphilitica the following seven remedies have
been found efficacious: ACID. MUR., Arsen., Caustic., Crot.,
DULCAM., Rhus tox., Sabina.
Condylomata are controlled with tolerable certainty by
Aurum, Causticum, Phosphoric acid, MERC. SOL., THUJA.,
and SABINA.
Alopecia syphilitica requires: Arsen., Cale. carb., Carbo.
veg., Graph., Hyper., old., Kali carb., LYCOP., Magnesia
carb., MERdUR., Natr. mur., NITRI ACID., Petrol., Phosphor., Selen., Sepia, Sulphur.
To onychia syphilitica the following remedies are adapted:
Arsen., Antim. crud., GRAPHIT., Hep. sulph., Kali carb.,
Lycop., MERC., SOL., Nux vom., Petrol.
(Among the above named remedies those which are printed
in fat type, have the nearest resemblance to the disease, and
may, as a general rule, be tried first. In all syphilitic diseases
the Mercurial preparations occupy the first rank. Acidum
nitricum  and Iodine, with their compounds, are likewise
powerful anti-syphilitica, and deserve especial attention in
the case of mercurial complications;  this remark likewise
applies to Aurum and its compounds. Next to these we have
Silicea, Mezereum, Acidum  phosphoricum, and the class of
remedies generally indicated for scrofulosis and tuberculosis.)
III. IRITIS SYPHILITICA.
This disease is intermediate between secondary avd tertiary
syphilis, and is by some authors reckoned among the former,




IRITIS.                      143
by others among the latter variety. Ricord places it among
the forms of secundary syphilis. We feel disposed to do the
same, for we have often met it in conjunction with roseola,
lichen and other syphilides.  According to Helbert, about
four out of every hundred patients affected with secundary
syphilis are attacked with iritis. There are, however, syphilitic eye-diseases, and iritis is one them, which are evidently
forms of tertiary syphilis.  These diseases will be treated of
in detail in the chapter on tertiary syphilis.
We will now go into some details regarding secundary iritis.
This disease is characterized by a very violent inflammation of the membrane of Descemet, especially on the anterior
surface of the iris, which results in dimness of the cornea,
yellowish or greenish discoloration of the iris, contraction or
distortion of the pupil, morbid dilatation thereof (mydriasis),
excessive photophobia and nocturnal pains in the orbit.
In most cases syphilitic iritis affects one eye only, and has
all the properties and appearances of common iritis.
In the commencement of the disease, the color of the iris
becomes duller, grayish, the smaller circle is less clearly distinguished from the larger, the radii are more or less effaced.
The pupil is moved with difficulty, more or less contracted,
its shape is altered, angular. The cornea is somewhat dimmed
and on the inner surface we discover a few bundles of vessels.
The whole of the sclerotica is filled with blood, of a rose
color; at its juncture with the cornea we perceive a dark-red,
more or less broad, violently inflamed, ring. The patients
complain of a drawing and a dull pressure in the eye, photophobia, increased secretion of tears; the sight is blurred as if
a gauze were before the eyes,
After a while these changes become more intense and
spread.  The iris becomes more discolored, almost of a dirtyred color. This change is particularly distinct in the case
of gray and blue eyes; blue eyes generally change to a
greenish-red. The surface of the iris is lined by a layer of
exudation of more or less thickness; this causes the iris to
swell, its free margin is thickened, and upon its anterior sur



144                 SECONDARY SYPHILIS.
face we discover globular elevations of a yellow or gray color.
The pupil is perfectly immovable, contracted and distorted.
In the substance of the iris we discover small extravasations
of blood, abscesses, forming upon its anterior surface small,
rounded, yellow elevations, and at its free margin reddishyellow, roundish flocks or globular, pedunculated excrescenses,
termed condylomata of the iris.  As the disease progresses,
adhesions take place between the iris and the lenticular capsule. If, in such a case, the pupil still remains open, it does
not look black but grayish. At the bottom of the anterior
chamber we observe through the dim cornea a more or less
elevated layer of pus which is sometimes mixed with blood.
As the disorganization progresses, the pain increases in violence. The patient experiences violent, constrictive, boring
pains and stitches spreading to the temples, forehead and
even the cheeks. The pains are worse in the evening and at
night, so that the patients have scarcely ever any sleep. If
the disease is not speedily arrested, it may spread to the other
membranes of the eye, causing amaurosis, specks on the
cornea, stamphyloma, mydriasis, etc. The lighter degrees of
iritis are speedily controlled by judicious treatment; but there
remains a tendency to relapses, on which account the patients
have to observe great caution for some time to come.
In treating the disease, we have above all things to protect
the eye from the light.  This is done by wearing a green
screen before the eye, and by abstaining from any work that
might strain the eye, such as reading or writing.  It may
even be necessary to keep the patient constantly in a dark
room.
Among the homoeopathic remedies the principal is  ere. sol.,
provided the patient had not been drugged with mercury by
some allopathic physician. If this should have been the case,
we have to give: Acid. nitr., Aurum, Belladonna, Cannabis,
Carbo veg., Crocus, Coffea, Graphit., Hepar sulph., Kali
carb., Lycop., Pulsat., Sulph., Thuja, Veratr.
[It is doubtful whether such agents as Crocus and Coffea
will be of any direct use in syphilitic iritis; the remedies from




TERTIARY SYPHILIS.                 145
which positive benefit may be derived in this affection, are
Acidum nitricum, Mercurius solubilis and corrosivus, and, if
there should be intense pain in the frontal region, and rapid
distortion of the pupil, the saturated tincture of the root of
Aconite. It is well to use this agent in alternation with
Mercurius corrosivus.]
Tertiary Syphilis.
According to Ricord, the symptoms of tertiary syphilis
differ from those of secundary syphilis in this, that they are
no longer transmissible to the fetus. Ricord maintains that,
at this period, the syphilitic disease loses its specific character,
and that it becomes a dyscrasia which is very much analogous
to scrofulosis. The older the syphilis, and the longer it lasts,
the more it becomes divested of its specific character.  Tertiary symptoms are always preceded by primary and secondary
phenomena.  Physicians who dispute this point, have certainly forgotten to institute a careful subjective and objective
analysis.
Tertiary symptoms are much more formidable than the conditiois by which they were preceded, and are the more serious
the longer and more diversified had been the anti-syphilitic
cures which the patients had undergone. The mercurial treatment, especially, renders the tertiary symptoms inveterate.
Mercury enfeebles the body, and the syphilitic disease is the
more frightful the more debilitated the constitution in which
it exercises its ravages.
Tertiary symptoms seldom  show  themselves under six
months after the disappearance of the chancre. This is the
shortest period. As to the period beyond which the action
of the syphilitic poison need no longer be apprehended, it is
impossible to determine it with any thing like certainty.
Cases have occurred where the syphilitic disease broke out
ten, fifteen, twenty years after the first infection; but such a
long period rarely ever elapses without the occasional supervention of suspicious symptoms. There is always some little




146                 TERTIARY SYPHILIS.
trouble which the patient overlooks on account of its insignificance.  But suddenly the disease breaks out; a steady
pain is felt in one of the tibiae, or a testicle begins to swell.
Tertiary symptoms affect the sub-cutaneous and sub-mucous
cellular tissue, the fibrous, osseous and cartilaginous tissues,
the muscles, nerves, parenchymatous organs; in short, the
whole organism.
Accordingly, we distinguish affections of the sub-cutaneous
and sub-mucous tissue, of the cellular tissue, and of the lymphatic glands and vessels enclosed in it.
Tertiary symptoms of the fibrous and parenchymatous
organs.
Syphilitic diseases of the periosteum and bones.
Syphilitic affections of the muscles and tendons.
Syphilitic affections of the eyes.
Syphilitic affections of the nerves.
Syphilitic affections of parenchymatous organs and syphilitic
cachexia.
I. TERTIARY AFFECTIONS OF THE SUB-CUTANEOUS AND SUBMUCOUS TISSUE, THE CELLULAR TISSUE, THE LYMPHATIC
GLANDS AND VESSELS.
Gummata Syphilitica, Gummatose Tumors on the S7cin and
in Parenchymatous Organs.
These tumors are located in the sub-cutaneous, sub-mucous
or interstitial cellular tissue. They are found more frequently
under the skin or under the mucous membranes than more
deep-seated. They are not often met with, belong to the
remotest stage or period of constitutional syphilis, and not
unfrequently accompany syphilitic -cachexia.  They run a
slow course, and are liable to relapses.
Gummata occur most frequently under the scalp, the skin
of the neck, upper arms, legs, especially on the inside of the
thighs and legs, on the prepuce and under the skin of the
penis and scrotum. At first we observe a pea-shaped, round,
very hard, not very prominent swelling under the skin; whose




GUMMATA.                      147
color is not altered in the least. These swellings are painless,
and it is only during a change of weather that a slight, dull
pain is experienced in the part where they are seated. They
increase slowly in size; sometimes a year elapses before they
reach the size of a hazel-nut. They seldom occur singly, but
are generally disposed in a row, like beads, from four to six
together. For a long time they remain hard, can be moved
to and fro over the subjacent parts, but their upper surface firmly adheres to the skin. These swellings frequently
remain unaltered for years. Finally, however, in one case
sooner, in the other later, they become soft. In the centre of
the tumor pus begins to form, and this change keeps spreading
to the circumference.  In the meanwhile the gumma has
formed adhesions with the adjoining parts, and is enclosed as
in a kind of cyst. The process of softening takes place in
the interior of the cyst, and, after awhile, fluctuation is perceived through the walls of the cyst, and becomes more and
more distinct. Gradually the formerly hard gumma acquires
the consistence of an abscess filled with pus. The skin over
the swelling, the color of which had remained unaltered so
far, now changes to a bluish copper-color, becomes thinner,
breaks, and a fetid ichor is discharged from the tumor. This
ichorous exudation sometimes undermines the neighboring
cellular tissue, forming widely-ramified fistulous canals.  At
this period, the discharge of ichor is generally accompanied
with portions of organized tissue. The ulcerative process
extends more and more, both in breadth and depth, the edges
of the ulcer look suspicious.
Gummata of the sub-mucous cellular tissue of the tongue
deserve especial mention. Syphilitic tumors of the tongue
are frequently confounded with diseases of an entirely different nature.  They have been mistaken for cancer and
schirrus, and have been cut out.  These sub-mucous gummata of the tongue develope themselves without the patient
being made aware of it by any symptom of pain. The tongue
becomes hard, knotty, either in one portion only or throughout its whola extent. The free motion of the tongue in talk



148                TERTIARY SYPHILIS.
ing or chewing is of course impeded. These swellings may
be distinguished from cancer by the absence of the shooting
pains which are always felt in the latter.
The most suitable remedy for these gummata is undoubtedly Mere. sol. which will always have the desired effect,
provided the patient had not been drugged with allopathic
doses of calomel. If this remedy should not suffice, one or
more of the following remedies will have to be chosen:
Arsenic, Borax, China, Mezer., Mecur. dule., Plumb., Strac
mon., Rhus tox., RButa, (Garbo anim., Aurum, Belladonna,
Acidum phosphor., Calcar. carbon., Graphit., Juglans.
SYMPTOMATIC INDICATIONS.
[Arsenicum is particularly indicated when the suppurative
process has already commenced, and symptoms of a malignant character are developed; the pus is ichorous, thin,
corrosive, foul, and the swelling has a livid appearance.
China may be used after arsenic, if this should not help,
or in alternation with it; and if neither arsenic nor china
should make any impression, and the character of the pus
should remain unchanged, or if the tumor should seem to be
perfectly torpid and hard,
Carbo animalis may be employed with great advantage.
Mercurius dulcis may be given after Mercurius sol. had
been tried ineffectually.
Rhus tox. is excellent when the swelling is hard as stone,
or when a commencement of torpid inflammation becomes
visible.
Aurum may be tried after Mercury, in case this agent
should not have any effect, or in case mercury should have
been given previously, or by some allopathic practitioner.
In such a case
Nitri acidum, Calcarea carbonica, Acidum phosphoricumn
and Graphites might likewise be given with advantage.
These remedies are likewise useful if the swelling does not
seem to be impressed in the least by any of the previously
named remedies.j




SARCOCELE.                     149
Belladonna is indicated when the swelling looks inflamed,
and is very tender and hot, or a throbbing is experienced in
the tumor.
Juglans is indicated when the swelling begins to feel sore,
or symptoms of ulceration develope themselves. In such a
case
Mezereum,  calcarea carb., and Graphites will likewise
prove useful.]
II.  TERTIARY AFFECTIONS OF THE FIBROUS AND
PARENCHYMATOUS ORGANS.
Sarcocele syphilitica, orchitis syphilitica, syphilitic swelling
of the testes.
For a long time syphilitic sarcocele was looked upon as
identical with orchitis arising from gonorrhcea. The difference between these two forms of orchitis was first scientifically and  thoroughly accounted  for by Astley Cooper,
Dupuytren, but particularly by Ricord. In speaking of this
disease we shall adopt the masterly description by Ricord,
which is distinguished by clearness and correctness; without,
however, neglecting the more recent observations and views
of Hamilton, Helot and Moore.
According to Ricord syphilitic sarcocele which has also
been termed albuginea syphilitica, because the tunica albuginea is principally affected in this disease, constitutes one
of the first and most frequent symptoms of tertiary syphilis.
It usually affects one side only, although cases occur where
both testicles, or one after the other, are diseased. There
are scarcely ever any precursory symptoms; now and then,
but in a few cases only, the patients complain of acute boring
pains in the loins, generally at night; sometimes they complain of a painful pressure in the region of the kidneys, or
of a sensation as if a sticking instrument were thrust through
their flesh. In some cases the nocturnal appearance of the
pains denotes an evidently syphilitic origin. As a general
rule, however, the precursory symptoms are wanting; the




150                 TERTIARY SYPHILIS.
testicle begins to swell without the patient being at all
aware of it. Some, however, liave their attention called to
the approaching  trouble  by  a sensation  of troublesome
tension and a dull pain in the testicles prior to any appearance of swelling., Most frequently the alteration is unaccompanied by any striking phenomena, and developes itself
in the following manner: in the testicle which is the seat of
the disease, we discover one or more indurated nodes; on
pressing the testicle we feel a small spot that is harder and
less elastic than the other parts.  As the disease progresses,
this induration continues to spread.  In  many cases the
induration spreads round about like a circular belt; in other
cases several indurations make their appearance successively
and gradually coalesce until the whole testicle has become
involved.
In simple cases, where the sarcocele runs a regular course,
the epididymis remains unaltered for a long period, and can
be clearly distinguished from the testicle proper which either
preserves its normal volume while the induration is going
forwards, or becomes hypertrophied.  But even if the testicle swells, the swelling never goes beyond certain limits,
and this is another diagnostic sign of syphilitic sarcocele, for
in many other forms of disorganization of the testes, such as
elephantiasis, fungous enlargement, this organ may acquire'an enormous size.
The increase of the swelling in syphilitic sarcocele takes
place with great regularity. The testicle preserves its pearshaped form, the larger extremity being turned downwards,
and the elongated extremity upwards, and the longitudinal
diameter in the direction of the spermatic cord.  The syphilitic testicle feels harder than the other; the hypertrophy is
regular; the inequalities which we discover with the finger,
observe a certain regularity; they constitute a regularly progressive series of circular or zone-shaped indurations. As
soon as the swelling has reached three or four times the size
of the original testicle, the epididymis is no longer perceptible
even upon close examination; an oval swelling is all that we




SARCOCELE.                      151
discover; nevertheless the epididymis is not morbidly altered;
neither the epididymis nor the vas deferens is involved in
any degree in the process of degeneration.
This is a very important diagnostic sign; for degeneration
of the epididymis or spermatic cord would constitute a most
unusual complication.  If the sarcocele attains a certain
degree, the testicle loses in mapy cases the sensibility which
it possesses in the normal state.
The swelling is hard, firm, not elastic; if pressed upon by the
finger, the tumor conveys the sensation of a massive, fibrocartilaginous, unelastic texture.  The outer skin appears
unaltered, keeps its natural color, remains cold, and can be
moved to and fro over the swelling, to which it does not
adhere. Only in a few cases some of the veins of the scrotum
appear somewhat engorged.
Sarcocele, after it has reached a certain stage, is sometimes accompanied by hydrocele of the tunica vaginalis.
This seems to be purely symptomatic, and is unaccompanied
by fever or by any general derangement of the functions.
After the internal texture of the testicle has become disorganized, the seminal secretion gradually ceases, especially if
both testes are diseased. The erections become less frequent
and finally disappear altogether.
The physical properties of the semen undergo striking
alterations in regard to quantity and consistence; the spermatozoa disappear, and, instead of semen, a transparent,
almost watery fluid is secreted.
Syphilitic sarcocele may last months, and even several
years. It never terminates in suppuration, nor does it ever
transgress certain limits. After reaching a certain point, it
here remains for a time, after which resolution takes place.
This either takes place spontaneously, or in consequence of
adequate treatment.  Sometimes it happens that the testicle
grows smaller in size; the patients consider this a good
omen, endeavor to hasten the disease, but unfortunately this
does not stop until the testicle has disappeared altogether.
In such a case other phenomena, which are generally met




152                 TERTIARY SYPHILIS.
with in eunuchs, supervene; for instance, the whole organism
undergoes a change, the whole appearance and condition of
the patient become altered, the voice loses its resonnance, etc.
There are cases where the disease takes a different turn;
the swelling changes to a cartilaginous, fibrous and even osseous
tumor.  Ricord has seen several changes of this kind, and
I have come across two such cases in my own practice.
Ricord has been led to believe by some cases that, if the
vessels have not become atrophied, syphilitic sarcocele may
terminate in simple resolution, and that the organ may again
acquire its normal shape.  We saw a case of this kind in his
clinique; the patient died of inveterate syphilis, but a few
months before his death, the testicle had resumed its natural
shape and consistence.
According to Hamilton, syphilitic sarcocele only takes place
from one to six years after the primary infection. He distinguishes two forms of the disease, the simple syphilitic
and the tuberculous syphilitic.  The former, he thinks, only
befalls robust individuals, and is accompanied by secundary
and tertiary symptoms, such as papulae, pustules, scales,
iritis, the lighter forms of ostitis and periostitis, etc. According to his statement the syphilitic tuberculous form is much
more frequent than the former from which it differs in many
essential particulars.
The penetrating Rokitansky, whose impartial and faithful investigations in pathological anatomy are of inestimable
value for a correct knowledge of the diseased tissues, in
reference to sarcocele, says: Chronic inflammation of the
tunica albuginea and of the processes which it sends off
towards the inner parts, occasions in rare cases only a considerable thickening of the  fibrous membranes, material
enlargement of the cellulo-fibrous tissue in the interior of the
testicle, hypertrophy, a morbid hardness of the testicle, and
finally atrophy."  In reference to tuberculous syphilitic sarcocele, Rokitansky offers the following remarks: "Tuberculosis of the testicle principally affects young persons in
consequence of excessive or unnatural gratification of the




SARCOCELE.                     153
sexual passion; pathological anatomy has not yet succeeded
in determining the connection of this disease with gonorrhoea;
in other words, the blennorrhoeic character of the constitutional disease and of the tubercle have not yet been proven,
and the theory, that syphilitic sarcocele is an" effect of gonorrhoea, lacks, in our estimation, an essential foundation.
Tuberculosis of the testis generally developes itself in the
shape of nodes, from the size of a millet seed to that of a pea,
and coalescing into a shapeless mass, which scarcely ever
terminates in resolution, but almost always in suppuration,
and constitutes phthisis of the testicle.  The increase of
volume depends upon the number of tubercles and particularly upon the number of tuberculous groups, the tumor
having an uneven, knotty surface.  The tissue which surrounds the tubercle and its vomica, feels thick and callous, is
dense, cartilaginous, resembling lard.
As in the lungs and pleural cavities, tuberculosis of the
testicle is frequently accompanied by inflammation of the
tunica albuginea leading to tuberculous deposits of a variety
of shapes."
This shows that tuberculosis of the testis must be the
result of a deeply-penetrating action of the syphilitic virus,
and that there is an essential difference between gonorrhoeal
orchitis and syphilitic sarcocele.
As regards the causes and developments of syphilitic sarcocele, Ricord considers not only syphilis, but all other
influences which act upon the testicle, as causes of this disease. Whatever exercises an irritating and exciting influence
upon the testicles, may contribute to the development of sarcocele. Gonorrhoea contracted during the course of secondary
syphilis, may excite the disease. Other causes, such as a
contusion of these parts, a blow, excessive abstinence or else
excessive indulgence, may likewise favor the development of
sarcocele during secondary or tertiary syphilis.  Sometimes
the syphilitic dyscrasia is complicated with a cancerous,
tuberculous, scrofulous diathesis; in such a case syphilitic
sarcocele is likewise more easily developed.
11




154                TERTIARY SYPHILIS.
Syphilitic sarcocele is found complicated with all sorts of
disorganized secretions, such as: varicocele, hydrocele, which
is quite frequent; acute and chronic gonorrheeal orchitis,
simple orchitis, cysts and hydatids, and other forms of disorganizations.
The prognosis depends upon the simple or complicated
nature of the disease. The less complicated the trouble, the
sooner a gentle and rational treatment is instituted, the less
the patient has been'subjected to violent treatment: the more
favorable the prognosis.
For syphilitic sarcocele, the following medicines have been
found the most efficacious: Calcarea carb., Garbo veget.,
Aurum, Kali carb., Lycopod. and Spongia tosta.  But it may
likewise be necessary to use one or more of the following
remedies, according as they may be indicated by existing
symptoms:
Acid. nitr., Acid. phosph., Alumina, Arsenicum, Belladonna, Baryt. mur., Clemat., China, Copaiva, Euphor.,
Graphites, Lycopod., Mercur. sol., Mezerum, Oleander,
Plumb. acet., Pulsat., Ranune. bulb., Rhodod., Rhus tox.
(The symptomatic indications for each of these remedies
iw particular imply a careful investigation and an accurate
knowledge of the syphilitic disease from the beginning.  In
no other way would it be possible to arrive at a knowledge of
the appropriate remedy in a case where sarcocele is apparently the only symptom, and may exist unaccompanied by
any characteristic constitutional phenomena.  An investigation of the whole series of symptoms constituting  the
syphilitic disease, will then first lead us to such remedies as
Acidumn nitricum, Clematis, Copaiva, Mercurius sol., Mereurius corrosivus, Mezereum, which seem to be more closely
related to the syphilitic virus.
Arsenicum, China and Acidum phosphoricum, Plumbum
acet., if the general constitution seems to be broken down,
debilitated, the vital fluids seem  to be tainted, or if the
disease had been hastened by excesses;
Mereurius, Clematis, Copaiv., Pulsatilla, if mismanaged




INDURATION OF THE CORPORA CAVERNOSA.    155
gonorrhoea was either the immediate cause of the disease, or,
at any rate, had complicated and aggravated it;
Belladonna, if symptoms of inflammatory congestion
develope themselves in the tumor;
Graphites and ilycopodium, Oleander and Belladonna, if
the disease is complicated with general scrofulosis, glandular
swellings, chronic eruptions, as if it had grown worse and
become more inveterate in consequence of the sudden suppression of a cutaneous eruption by a cold, washes, etc., in
which latter case Baryta mur., Rhus tox., may be added to
the last mentioned drugs.)
Induration of the corpora cavernosa of the penis.
This is one of the least known and least frequent phenomena of tertiary syphilis.
To our knowledge Ricord is the only author who has given
an exact and correct description of this disease.  He has
observed some eighty cases, and, although the disease is very
rare, yet he states that some eight or ten cases occur every
year in his private or hospital practice. In our own practice,
we have had a few cases of this disease to treat.
The induration of the corpora cavernosa generally developes itself in the following manner: In one or in both
corpora cavernosa at the same time, the patient discovers,
among other symptoms of tertiary syphilis, a small, hard
body of the size of a grain of rice, which is, however, entirely
painless.  This hardness increases in size, either on  one
side, or on both sides at the same time, and may occur ini the
upper or lower portion or in the sides of the penis.
This disease runs a slow course, progresses very gradually,
and is painless; but in proportion as the disease progresses,
the penis deviates from its straight linein the following manner: If the induration is located on one side, the penis, if an
erection takes place, will necessarily be turned towards the
diseased side, where the erectile tissue has lost its dilatable
character; this kind of erection, with the point of the penis
turned towards the inguinal fold, has been termed, by Ricord,




156                TERTIARY SYPHILIS.
inguino-crural erection. If the induration is,seated on the
dorsum of the penis, the erection takes place upwards, the
penis forming a curve with the concavity upwards and the
glans turned towards the pubic arch. Ricord likewise saw
the penis turned in other directions in consequence of an
induration of the cavernous bodies; in some cases he saw it
twisted like a ring.
[This affection never terminates in suppuration, and is frequently incurable. It is Ricord's opinion, though he does not
give it as positive, that a violent gonorrhoea is, in most cases,
the cause of this disease. In many cases the primary cause
of the disease seemed to have been an act of violence'committed while the penis was erect. He relates the case of a
young student of medicine, where the disease seems to have
resulted from a sudden apoplectic effusion of blood into the
substance of the cavernous bodies.  During a very violent
erection the young man experienced an acute pain, apparently
caused by a rupture of the cells, after which an effusion of
blood took place, and coagula formed in the bodies, which
could not be removed by absorption.
In this affection the following remedies will be found the
most suitable to palliate, if not to cure, the disease:
Argent. nitr. Copaiva, Graphites, Hepar sulph., Mercur.
acet., Mezer., Sabina.
In regard to symptomatic indications, we refer the reader
to our remarks in the preceding paragraphs. The indications
in the present case are the same. Not one of the remedies
above mentioned can be said to be homoeopathic to the disease
upon purely symptomatic grounds, for an induration of the
cavernous bodies of the penis has never been obtained by
artificial drug-proving; the homoeopathicity of the remedy
to the disease in all such disorganizations must be traced
back to the original conditions, to the starting-point of the
disease, as well as to the starting-point of the drug-action;
if these are alike; the remedy is homoeopathic, and, if a cure
be possible, and the medicine be properly used, a cure will
undoubtedly be effected.  All such disorganizations may,




BONE-PAINS.                     157
however, result from a complication of morbid miasms, syphilis, scrofulosis, tuberculosis and the like; and it may, therefore, be necessary to have recourse to more than one remedy
during the treatment.
To the syphilitic and gonorrhoeal dyscrasia correspond the
mercurial preparations: Argent. nit.,  Copaiv., Miezer.,
Thuja, Sabina, Acid. nitric., Pulsat., Canthar., Cannabis.,
Aurum, Silicea, etc.
To the scrofulous and tuberculous dyscrasia: Calcarea,
Graphites, Lycop., Bellad., Arsenicum, Sulphur, Hepar
sulph., China, Dulcamara, etc.
In the case of hsemorrhage related above, the best remedy
would undoubtedly have been Aconite, for the excessive erection was undoubtedly the result of an excessive congestion of
the parts, and not the hemorrhage a result of the erection.]
III. TERTIARY AFFECTIONS OF THE PERIOSTEUM AND BONES.
These affections manifest themselves under four different
forms, which, however, have to be regarded as different stages
and terminations of the inflammatory process, but not as different forms of the syphilitic disease in the bones., These
affections generally constitute the following successive series
of phenomena; syphilitic bone-pains (dolores osteocopi,)periostoses, exostoses and syphilitic necrosis and caries.
Syphilitic bone-pains, dolores osteocopi.
These pains may be located in any portion of the osseous
tissue, in the more deep-seated, as well as in the superficial
layers, in the flat or long bones, in the articular extremities
as well as in the shafts, and finally in the periosteum. There is
not a single spot in the whole body that may not be affected by
this pain. As a general rule, however, these pains occur most
frequently in the superficial portions of the fibrous and osseous
systems. Those portions of the bones which are less covered
by the muscles and are more exposed to the open air, are
most frequently invaded by syphilitic pains.  Hence they
occur more frequently in the tibia, radius, humerus, clavicle,




158                TERTIARY SYPHILIS.
sternum and in the bones of the skull, than in the more deepseated bones. As a general rule, the compact portions of the
bone are more frequently invaded by the pains than the
spongy portions.
Bone-pains are to be numbered among the remotest manifestations of constitutional syphilis, and constitute in the true
sense of the word tertiary phenomena.  There is no case on
record-where bone-pains occurred, before five or six months
after the, primary chancre had elapsed. They may occur
even ten, fifteen or twenty and even more years after the
primary disease.
B6ne-pains are most frequently caused by a sudden change
in the weather.  Although a sudden change from warm to
cold weather favors the development of bone-pains, yet the
inverse transition from cold to warmth, if the bone-pains are
already developed, renders them much more acute. Hence
it is, that they are very much aggravated when the patient
goes to bed and begins to get warm. These nocturnal exacerbations of the bone-pains are exclusively attributable to the
influence of the warmth of the bed. It is, therefore, wrong to
consider the nocturnal exacerbations of the bone-pains a characteristic sign of their syphilitic character, and to term them
dolores nocturni, as though they occurred preferably at night.
Ricord states in reference to this subject, that these pains are
felt at night only by those who go to bed at night, and get
warm in the bed; but that they are not felt by those who
spend the night in carousing; such persons only feel the
pains in the day time while they are in bed and exposed to
its warmth; in their case the pains would have to be called
dolores diuturni. But they deserve neither one nor the other
appellation, but simply increase by rest and the warmth of
the bed, whether this occurs in the day time or at night.
Ricord states, that among the rich who spend the summer in
the country and the winter in the city, the bone-pains are felt
at night in the summer, and in the day time in the winter;
the reason of this is quite simple: in the winter the rich spend
their nights in social entertainments and sleep in the day




BONE-PAINS.                    159
time, whereas, in the summer, they sleep at night and spend
their days with fishing, hunting, riding on horse-back, and
such like exercises.
In most cases, if the patients go to bed in the evening, the
pains commence at eleven o'clock in the evening, and continue
until two or three o'clock in the morning.
Syphilitic bone-pains always begin with a disagreeable sensitiveness. This gradually increases to a pain, until it finally
changes to a frightful torture. It is peculiar to this pain to
become seated in one spot'of the bone, and always to reappear
at the same place. The pain is aggravated by the least pressure, which is not the case when it is simply a rheumatic pain.
After the pains have lasted for a time, they are not only
excited by the warmth of the bed, but they are felt in the day
time as well as at night, except that they are aggravated by
rest. Syphilitic bone-pains may continue for a longer or shorter
period without any alteration of the bone in the region where
the pains are seated, becoming perceptible; they resemble
neuralgic pains. Very often, however, these pains are the
precursory symptoms of material changes of the bones which
develope themselves speedily in some, and more tardily in
other cases. Many patients experience these pains for months
without perceiving any other change than a derangement of
the reproductive functions and an increasing emaciation.
Syphilitic bone-pains most frequently terminate in periostosis.
The treatment is most efficaciously conducted by the following remedy:
Calcarea carbonica, Carbo. animalis, Caustic., Croc., Fluor.
ac., Kali carb., Lac les., Lycopod., Magnes. carb., Miercur.
sol., Mezer., Natr. mur., Nux vom., Platin., Plumb., Plumb.
acet., Petrol., Phosphor., Pulsat., Rhododend., Staphys.
[In regard to the special indications, we have to observe,
that the principal remedies for this disease, provided the
patient had not been saturated with mercury under allopathic treatment, are, 1, the mercurial preparations, Mere. sol.,
dulcis, corrosivus, ruber, acetatus, etc.; 2, the Hydriodate of




160                TERTIARY SYPHILIS.
potash, if a good deal of mercury had been used, in which
case it may be advisable to give the patient a few table-spoonfuls of an infusion of Sarsaparilla every day; 3, Nitric acid,
and some of its compounds, such as the Nitrate of potash.
In addition to these remedies, Fluoric acid, Mezereum, and
Staphysagria may be employed, the two last named remedies
more particularly, if the region where the pain is located feels
sore, as if ulcerated.
Lachesis will be found useful, if the mercurial preparations
had been employed to excess, or if mercury remains ineffectual under homoeopathic treatment.
Ifthere should be a complication with scrofulosis, and the
patient should have been troubled in his childhood with weakness of the osseous system, rickets and such like diseases, we
may select our medicines accordingly, and use for instance,
(alcarea carb., Phosphor. and Phosphor. acidum, Pinus sylvestris, likewise China and Arsenic., the two latter more particularly if the constitution is shaken and requires building up.]
Periostitis syphilitica.
After the syphilitic bone-pains have continued for a length
of time, alterations in the tissue of the periosteum begin to
take place.  The periosteum becomes inflamed, and exudations become distinctly perceptible when pressing upon the
part.  The exuded matter at first looks yellowish, of a gelatinous consistence, and, after a while, changes to a reddish or
brownish fluid mixed with extravasated blood.
Syphilitic periostitis generally developes itself in the region,
where the pain had been felt.  At this place we discover a
rather circumscribed swelling of a greater or less extent, and
with its base firmly adhering to the subjacent bone.  The skin
over this swelling is moveable, and its color seems unaltered.
Gradually the swelling increases to the size of a pigeon's or
hen's egg.  The swelling is owing to the presence of the
exuded matter between the periosteum  and the bone, and
resembling synovial fluid.
The swelling on first developing itself, is rather firm; it




EXOSTOSIS.                    161
does not fluctuate, but, when pressed upon, does not impart
the sensation of a hard, resisting bone. Such swellings may
increase to a considerable extent, but may likewise scatter
without leaving a trace of their existence. A complete dispersion can only take place provided the exudation has not
terminated in an actual disorganization. If no suitable treatment is instituted previous to such a result, an osseous degeneration (exostosis) is very apt, to take place. Such osseous
tumors arising from the consolidation of the plastic exudation,
are termed tophi.
Periostitic inflammations resulting in exudations under the
periosteum resembling the synovial fluid, are termed gumma,
gummata.
Exostosis.
These swellings are always preceded by periostitis, and do
not develope themselves until the bone-pains have lasted for
a time.  They run a very slow course.  They arise from an
osseous disorganization of the plastic exudation in periostitis,
a disorganization which takes place in a similar manner as
the callus in the fracture of bones. The morbid process commences partially in the periosteum and in the superficial layer
of the compact bony substance which is thickened by an
additional layer of osseous exudation between the bone and
the periosteum. On its surface the exudation is cartilaginous;
the deeper layers exhibit an osseous consistence. After the
exudation has lasted for a time, it acquires throughout the
consistence of bone, and is of various thickness. At first the
surface of the swelling is rough, sometimes as if covered with
warts; the older the swelling, and the more it acquires the
consistence of ivory, the more its surface becomes smooth and
even.
These rather superficial exostoses are of various shapes;
sometimes they form  a flat, extensive layer, resembling a
simple distension or swelling of the original bone; at other
times the exostoses constitute fusiform, pad-shaped, round or
prominent, knotty, and even pedunculated tumors.




162                TERTIARY SYPHILIS.
In other cases the exostosis commences in the interior of
the bony substance, or on the inner surface adjoining the
diploe or marrow. The exudation taking place within the
bony substance, the bone grows thicker and harder; the
tumor which encroaches upon, and sometimes fills up entirely
the hollow interior, acquires the consistence of ivory, and, on
its outer surface, represents a flat, round elevation. Sometimes, several of such exostoses are placed side by side, at
first isolated, but afterwards coalescing.  In the commencement of the disease, the patients do not complain of any pain
except the bone-pains.  These continue often for a long
period before the exostosis shows itself, and abate as soon as
the bone begins to swell. The exostosis never terminates in
suppuration, nor does it even become carious.  It either
remains unaltered during the patient's life-time, or a gradual
reduction is effected by suitable treatment, sometimes after
the tumor had been in existence for years. An exostosis may
arise in a locality where it may give origin to a variety of
distressing secondary phenomena.  Large exostoses on the
lower extremities impede motion, and render it painful, interfere with the functions of the muscles and tendons, and may
lead to atrophy of the part. Exostoses on the inner surface
of the skull may cause all that train of phenomena consequent upon pressure of the brain and of its membranes such
as paralysis, spasms and so forth.
The following remedies will be found the most adequate to
the complete or partial reduction of syphilitic periostoses and
exostoses:
Asafoetida, Aurum, Bryon., China, Conium, Mercur. sol.,
Mezer., Phosphor., Ruta, Sabina, Sepia, Silicea, Sulphur,
Stannum, Staphysagria, Thuja.
[To these remedies we should add the hydriodate of potash.
Aurum, Phosphorus, and the phosphate of lime, also Ruta,
seem to be particularly adapted to exostoses of the cranium;
the two last named remedies more particularly if the syphilitic
dyscrasia is complicated by scrofulosis.
Asafoetida, Mercurius, the Hydriodate of potash, Staphy



CARIES AND NECROSIS.                163
sagria and Silicea, will be found particularly useful in exostoses of the long or hollow bones.
Thuja and Sabina refer more especially to a sycosic character of the tumor.
Acidum nitricum and the hydriodate of potash are suitable
remedies when we have reason to suspect a complication of
mercurial and syphilitic dyscrasia.
The mercuridl preparations are undoubtedly the principal
remedy for this disorganization, and the treatment may safely
be commenced with them, provided mercury had not been
previously administered in allopathic doses; and even then,
small homoeopathic doses of mercury, if judiciously administered, may be of great use in this disease.
Ledum palustre may be given for hard tubercles and tophi
in the joints. The mercurial preparations are likewise indicated for this affection, if accompanied with arthritic pains
in the joints.
Rhus tox. is another remedy for swelling of bones, if the
parts are painful and the pain is worse during rest than
during motion, with a sense of paralytic numbness and weakness in the parts.
Sulphur has likewise been used with advantage for swelling
and curvature of the bones.]
Syphilitic caries and necrosis.
We have seen that syphilitic periostoses and exostoses
result from a specific inflammation of the periosteum and of
the bone.  They may be considered as terminations of periostitis and ostitis, in the one case in resolution, in the other
in induration. A third termination of ostitis is suppuration.
This is the most pernicious, but fortunately the least frequent
of all the terminations of ostitis.  In compact bones, of low
vitality, the inflammatory process generally terminates in
exostosis, much less frequently in suppuration.
In bones endowed with a higher degree of vitality, if the
patients are sickly, and the osseous system  is disposed to
inflammatory conditions, syphilis will more readily lead to




164                TERTIARY SYPHILTS.
caries and necrosis.  Hence the spongy tissue of bones is
more easily attacked with caries and necrosis than the denser
tissue.
The termination in suppuration takes place in the following manner: the diseased part is exceedingly painful. The
pains continue day and night, only that at night the pains
are much more violent. The pain has the general character
of just such a pain as is experienced previous to the suppurative process setting in. First it is aching, tensive, afterwards throbbing, and increases in proportion as the suppuration is drawing near. Soon after the soft parts commence
to change, they coalesce with the tumor. At first this is circumscribed and resisting, afterwards it becomes fluctuating.
The abscess does not always open in the region where the
part is diseased; the pus may burrow  downwards between
the muscular layers; the skin  over the tumor becomes
inflamed and breaks spontaneously, unless opened, in several
places. At first fistulous abscesses form, all which lead to
the denuded bone.  Afterwards the pustules run together
into a larger abscess, at the bottom of which the carious
bone either lies exposed, or is partially covered by rapidly
suppurating, lardaceous layers, and afterwards by adventitious granulations.  The surrounding skin is quite red, and,
together with the subjacent parts, unites with the bone in
one compact mass.  With the suppuration and destruction of
the soft parts, the vitality of the bone gets lost, the calcareous portions are laid bare, so that the dead calcareous mass
alone remains.  This dead matter acts, in its turn, like a
foreign body, and helps to keep up the suppurative process.
But there are cases where the suppuration penetrates through
the osseous tissues, and the bony-mass becomes decomposed.
In the one case the bones begin to die as soon as the destruction of the soft parts commences; in the other case the bone
becomes ichorous, and is decomposed into larger or smaller
pieces.  The former disorganization is termed necrosis, the
latter caries.  These two disorganizations are frequently
found united.




CARIES AND NECROSIS.                165
Although any part of the osseous system may be marked
by caries, yet this disorganization befalls principally the
bones of the cranium, those of the face, and more particularly
the upper maxillary bones. It occurs very rarely in the submaxillary bone. The palatine bones are frequently attacked.
In many cases the affection commences in the corners of the
nose and the caries of the palatine bones is the result of the
affection of the adjoining soft parts, in consequence of which
the bones become denuded.  Very frequently the carious
perforations of the the palatine bones are caused by perforating tubercles of the nasal bones. The dental portion of
the maxillary bones is most frequently attacked by caries.
The parts which constitute the sockets of the teeth, swell,
and these more or less painful swellings are followed by
abscesses which raise the soft partq, and the fetid odor of
caries emanates from the suppurating disorganization. After
the breaking of the abscesses, the probe soon reveals the
rough surface of a carious bone. Afterwards, on examining
the teeth, it will be found that one tooth alone cannot be
shaken, but that, upon endeavoring to shake several teeth
together, the whole dental portion of the jaw is moved. If
this motion is distinctly perceptible, the bone is dead, and
there is no hope remaining of preserving it or reducing it to
its normal condition. The ascending processes of the palatebones generally remain free from caries; on the contrary the
nasal cartilages are principally invaded by this disease; the
vomer which has a denser tissue, becomes necrotic; the nose
caves in, the outer nasal bones are not destroyed, but the
form of the nose becomes nevertheless altered.
The bones of the cranium are likewise frequently attacked
by syphilitic caries and necrosis.
Syphilitic caries and necrosis of the jaw leads to the loss
of teeth, indistinctness of speech in consequence of the perforation of the palatine vault.
If the disorganization affects the nose, the loss of a few
cartilages may not be attended with any considerable inconvenience. But if the vomer and the other cartilages of the




166                TERTIARY SYPHILIS.
nose should be destroyed, the nose will cave in, and the shape
of the face will become considerably altered. The destructive process likewise invades the septum; the nose forms only
one cavity; the Schneiderian membrane becomes altered and
covered with a pseudo-plastic layer which secretes a peculiar,
fetid matter; some portions of the Schneiderian membrane
remain sound.  The matter which is secreted in the nose,
adheres; it is not expelled as readily as the common nasal
mucus, and it accumulates in large quantity.  There is a
secretion of purulent, ichorous matter continually going forward, having a sickly, nauseous odor.
Caries and necrosis of the skull-bones are likewise of frequent occurrence.  This condition is so much the more
important as it may lead to dangerous cerebral affections.
If the external plate is diseased, the cerebral functions
remain undisturbed, except the pain.  But the thing is
different, if the tumor is seated on the vitreous table; in
such a case violent headache, vertigo, tremor, numbness of
the limbs, and, after a period, semilateral paralysis of the
muscles of the face and remainder of the head, delirium and
epileptiform  convulsions may supervene.  Caries of the
frontal and parietal bones leads to inflammation and ulceration of the meningeal membranes.  Caries of-the frontal
bones results in perforation of the frontal sinuses, destruction of the cribriform plate and of the adjoining parts.
In caries and necrosis the following remedies will be found
useful:
Asafoetida, Aurzum, Argentum  nitricum, Baryta carb.,
Bellad., Bryonia, Calcarea carb., Caustic., China, Conium,
Dulcam., Mercur. sol., Mezer., Nux vom., Phosphorus, Pulsat.,
Rhus tox., Sabina, Silicea, Staphys., Sulphur.
[To this list we may add:
Tartar emetic, frictions with which, upon the skull, have produced caries of the skull-bones, and which may therefore be
supposed possessed of curative virtues in this disease.
Mercurius solub., has cured caries of the bones in general,




MUSCLES AND TENDONS.                 167
and caries of the joints, of the auricula auris, and of the maxillary bone in particular.
lMezereum has cured caries of the bones.
Calcarea phosphorata is useful in caries, also caries of the
skull.
Aurum foliatum is a great remedy for caries of the facial
bones, nasal bones and palate.
Hepar sulphuris in caries of the hip-joint, or in caries produced by abuse of mercury, for which Aurum and Silicea will,
likewise be found indicated.
Silicea has cured caries of the humerus, jaw-bone, malarbone, tibia, and vertebrae.
Calcarea carbon. is useful in caries of the vertebrae.
Cistus canadensis has been found of great use in caries of
the lower jaw, and of the facial bones; in the latter case it
was used as an infusion internally, and in the shape of a
poultice externally.
China, Conium  and Sulphur are adapted to mercurial,
scrofulous and syphilitic caries.
Asafcetida will likewise be found useful in mercurial and
scrofulous caries, although this remedy is generally much less
valuable than is supposed.]
IV. TERTIARY AFFECTIONS OF THE MUSCLES AND TENDONS.
Ricord terms these affections syphilitic contractions of the
muscles and tendons, and ranks them among the most curious
phenomena of tertiary syphilis. They are exceedingly rare,
and generally attack persons of advanced age who had been
syphilitic and exposed to repeated rains and colds.
The syphilitic affections of the muscles and tendons begin
with pains which are very similar to bone-pains, have intermissions like these, and are generally made worse by the
warmth of the bed.  Being  considerably aggravated by
motion, these pains have also been termed syphilitic rheumatism.  Even after the pains have lasted only a short
period, a permanent contraction of the muscles takes place.
The distortion of the limb caused by such contractions,




168                TERTIARY SYPHILIS.
developes itself very slowly. In general the disease runs a
slow course.  In the region where the pain is located, the
patient gradually experiences a sort of rigidity, a difficulty of
motion, especially when attempting to stretch the part; for
then the muscle feels as if it were contracted. Little by
little such a contraction really takes place; the limb remains
permanently bent.  The contraction never takes place suddenly as if caused by some sudden nervous derangement.
The starting-point of this contraction is not to be sought in
the brain or spinal column, but in the substance of the muscle
itself and in the alteration which the tissue undergoes.
Coagulable lymph exudes between the muscular fibres, forming after a longer or shorter period a fibrous, cartilaginous
and even osseous disorganization, which results in atrophy of
the part. The skin covering these muscular disorganizations
is moveable, and not at all altered in appearance. The neighboring lymphatic glands frequently swell. A change in the
weather causes pain in the muscular swelling.
Such muscular disorganizations generally take place in the
flexor muscles of the forearm, in the muscles of the eye, in
the sterno-cleido-mastoideus muscles, in the posterior cervical
muscles, especially the transversalis colli; in the pectoralis
major, the gluteus maximus, and in the gastrocnemius muscle.  These muscles and the corresponding parts become
contracted.
The tongue and lips are likewise liable to such contractions.
In the tongue the exudation generally takes place in a portion of the hypoglossus muscle only, very seldom in the whole
substance of the muscle. The tongue is swollen, the tumor is
hard and seated within the substance of the tongue where it
constitutes a more or less circumscribed, globular elevation,
which is exceedingly sensitive to motion. Talking, chewing
and even swallowing are impeded. This affection is frequently
confounded with cancer, not to the benefit of the patient. In
this affection there are never any lancing pains, nor is the
surface of the tongue indurated or warty as in cancer.
Syphilitic affections of the tendons are more frequent than




MUSCLES AND TENDONS.                  169
those of the muscles.  They are characterized by circumscribed, hard, rounded or irregularly-shaped thickenings,
which  are painful only at the  commencement.  These
tendinous swellings are likewise occasioned by exudations
in the sheath or in the substance of the tendons, which at
first are liquid, gradually become organised, and afterwards
acquire a calcareous consistence. The swelling constitutes
a perceptible prominence on the tendon, and, if situated on
tendons adjoining the skin, as in the palm of the hand, in
the wrist-joint, on the tendo Achilles, the skin and the
swelling coalesce; a few bunches only are perceptible to the
touch.
For tertiary affections of the muscles and tendons, the
following remedies will be found most appropriate:
Angustura spur., Aconit., Alum., Ammon. earb., Acidum
nitr., Arsen. Ammon. mur., Bellad., Baryt. carb., Berber.,
Coccul., Crot., Caust., (olch., Carb. animalis, ]Euphorb.,
Euphras., Graphit., Guajac., Hyoscyamus, Ignat., Indigo,
Kreosot., Laches., Lycop., Mercur. sol., Natr. mur., NVux
vom., Opium, Oleand., Plumb. acet., Petrol. Ranunc. bulb.,
Rhus tox., Sabina, Secale., Sarsap., Sepia, Spigelia, Stramon., Silicea, Spongia, Sulph., Thuja, Veratr., Zincum.
[Among this large number of remedies we have to distinguish
1.  Such as refer to purely syphilitic condition.
2.  Such as refer to syphilitic conditions complicated with
rheumatism.
3.  Such as refer to a complication of syphilis and scrofulosis; and
4.  Such  as correspond  to  syphilis complicated with
general debility.
Among the first class we number Acidum  nitricum, Kali
hydriodicum, Mercurius sol., Sabina, Thuja; the two last
named particularly, when the affection can be traced to
sycosis.
To the second class belong Aconite, Belladonna, Colehicum, Guajacum,,lIercurius solub., Nux vom., Sepia, Sulphur;
12




170                TERTIARY SYPHILIS.
Aconite and Belladonna being principally indicated when
inflammatory symptoms are present, the swellings feel hot
and sore, and the least attempt to extend the parts causes
pain.
Guajacum is more particularly indicated when the posterior
muscles of the legs are the seat of the disease, with lancinations from the feet upwards.
Mercurius, when the parts are stiff and ache, without the
pain being very acute; the patient feels chilly when exposed
to the least breath of air.
Colchicum may be used if Aconite seemed indicated but
did not produce the desired effect, or it may be given in
alternation with Aconite, especially if the derangement was
caused by exposure to wet or a draught of air; Rhus tox. is
likewise indicated in this disease.
Sepia, and Sulphur are more particularly adapted to chronic forirs of this disease.
The third class comprises the following remedies: Aconite,
Belladonna,  Baryt. carb., Graphit., Lycopod., Sarsap.,
Silic., Spongia and Sulphur.
Belladonna, Spongia, and Sulphur may be used first in
preference to the other medicines, not omitting, however,
the exhibition of the mercurial preparations which cannot be
dispensed with in any form of the disease.
If the syphilitic affection is accompanied with a general
sinking or debility of the constitution, we may use the
remedies mentioned  in  the  fourth  division, principally
Arsenicum, Baryta, Carbo. anim., China, Ignatia, Oleander, Plumbum acet., Sepia, Veratrum, although any of the
other medicines may likewise be indicated.]
V.  TERTIARY AFfECTIONS OF THE EYES.
Beside the iritis syphilitica which Ricord numbers among
the secondary affections of the eyes, he speaks of tertiary
affections of these organs, which have never been mentioned
before by any author.
Tertiary affections may either involve the eye itself, or its




AFFECTIONS OF THE EYES.                171
appendages, or the neighboring parts. These affections may
occur alone without any other part of the body being
diseased. Ricord treated patients for diplopia in whom,
after death, the muscles of the eye were found altered in the
same manner as other muscles are.  Most patients whose
eyes are affected in this manner have an excellent vision;
but as soon as they look upwards or sideways, every thing
appears to  them  double; this.alteration of the visual
functions occurs quite suddenly, and ceases again as soon
as the original direction of the eye is restored. In some
cases the muscles of the eye were contracted to such an
extent that the patient squinted. Ricord treated one patient
for strabismus convergens, the outer muscles having their
natural mobility and length.  According to this physician.
the most frequent contractions occur in the inferior rectus
muscle, in consequence of which the eyeball may be permanently drawn downwards out of its horizontal axis.
Beside these contractions of the muscles of the eyes, there
are alterations of the visual functions arising from syphilitic
affections of the sclerotica. This membrane may, like the
other fibrous portions of the body, undergo alterations of
tissue which exercise an important influence upon the shape
and functions of the eye. Alterations of the nervous structure of the eye may likewise lead to amaurosis.  Ricord
relates several cases of amblyopia occasioned by tertiary
syphilis, and the same author gives it as his opinion that
lenticular or capsular cataract may likewise arise from the
action of the syphilitic miasm upon the lens or its enveloping
membrane.
The following remedies may be of use in the treatment of
these affections of the eye:
Alum., Agaric., Ammon. carb., Arsenic., Aurum, Baryt.
carb., Bellad., Con., Digit., Euphorb., Graphit., Hyosc.,
lod., Nitr. acid., Petrol., Pulsat., Secale, Stram., Teratr.
[For contraction of the muscles of the eye, we may use:
Aconite, Belladonna and the more penetrating mercurial
preparations such as Mercurius corrosivus, dulcis, ruber.




172                TERTIARY SYPHILIS.
For disorganizations of the lens and membranes of the eye,
Belladonna, Arsenicum, Acidum  nitr., Cannabis, Iodine,
may be given.
For alterations of the nervous functions, we have Belladonna, Conium, Digitalis, Hyoscyamus, Stramonium, Tussiiago petasites.]
VI. TERTIARY AFFECTIONS OF THE NERVES AND CENTRAL
NERVOUS ORGANS.
Syphilis may affect the brain and spinal marrow idiopathically. Alterations of the meningeal membranes, after the
bones of the cranium or of the vertebral column have been
destroyed by syphilis, must necessarily affect the functions of
the brain or spinal column, but these derangements would not
be idiopathic. It is Ricord's opinion that the syphilitic poison
affects directly the nervous centres. In the brain of persons
who had died of syphilis, he found tubercles which bore great
resemblance to syphilitic deposits in other parts of the body.
Such tubercles in the brain or spinal marrow must of course
produce marked alterations in the cerebral or nervous functions during the life-time of the patient, And it is indeed
true that the motor and sentient powers of syphilitic patients
are affected in a manner which can only be traced to syphilis.
One of the most frequent disturbances of both the motor
and sentient nerves is paraplegia.  Ricord gives it as his
opinion, that syphilis is a very frequent cause of general
paralysis or paraplegia. It is only recently, that the discovery was made, that syphilis may cause a paralysis of the
seventh pair of nerves.  In the "Deutsche Klinik," Knorre
relates several cases of paralysis caused by syphilis, which he
treated in the Hamburgh hospital; among them two cases of
paralysis of the facial nerve, and several cases of diplopia and
amaurosis.
Epilepsy and catalepsy are likewise caused by tertiary
syphilis. Ricord relates the case of one of the most distinguished actors of Paris whom he treated some years ago for
syphilitic epilepsy. This gentleman had been treated in vain




DISEASES OF THE NERVES.               173
by a number of the most distinguished physicians of Paris;
Ricord undertook an anti-syphilitic course of treatment, and
removed the attacks in some months.
We must not forget to mention a peculiar derangement of
the nervous system caused by syphilis, and which is undoubtedly noticed by every practitioner;  Ricord terms it syphiliphobia.  This is one of the worst forms of hypochondria.
Without a single sign of syphilis being perceptible any where
in the patient's constitution, he nevertheless fancies that he is
affected with the disease.  This imaginary syphilis is a fixed
idea with such patients; it does not leave them by day or by
night; the least spot, pustule, pain, is a symptom of syphilis.
Such patients are a perfect burthen to themselves, to others,
and particularly to their physician; they come to him for
every little trifle, show him their tongues, ask him to examine
their private parts or the interior of the throat; the least redness and secretion of mucous causes them great trouble, and
confirms them in their apprehensions. They examine themselves in the looking-glass, look at their tongues, and feel
unhappy if they discover a few small papillae, or if the orifice
of the Stenonian duct excites their attention. In this way they
go about, physicking themselves as advised eitherby quacks
or physicians, until their constitution is ruined.
We have found the following remedies the most efficacious
in derangements of the nervous functions from  syphilitic
causes:
Acid. nitr., Anacard., Angust., Arnica, Arsenicum,
Bryon., China, Cocculus, Colchicum, Nux vom., Oleander,
Plumb., Plumb. acet, Sepia, Silicea, Stannum, Zincum.
[Anacardium will be found particularly useful when the
functions of the special senses, and the intellectual functions
are impaired;
Angustura for cramps, spasms of the spinal marrow,
especially when of a tetanic nature;
Arnica, Arsenicum  and China, when  the patient complains of debility, the flesh becomes flabby, looks sickly and




174                TERTIARY SYPHILIS.
sallow, the appetite is poor, sleep disturbed, the reproductive
functions are declining;
Nux vomica, for derangement of the sentient functions,
numbness and creeping in the extremities, spasmodic twitchings, constipation, load at the stomach;
Plumbum  acet., atrophied condition of the extremities,
paralysis, dulness of the mental powers;
Iodine, for a similar condition as Plumbum.
Zincum, general emaciation, colliquative discharges, chronic
headache, sleeplessness.]
VII.  TERTIARY AFFECTIONS  OF THE  PARENCHYMATOUS
ORGANS AND SYPHILITIC CACHEXIA.
We have shown in the course of this work, that the first
tendency of syphilis is to the skin and mucous membranes;
as it progresses it invades the fibrous membranes, the bones,
muscles, tendons, and even nerves. These different organs
are liable to the most horrible disorganizations from the
syphilitic virus, in consequence of which the organism is
sadly and frightfully undermined. But the destructive process goes much farther, and even invades the parenchymatous
organs of the  interior cavities.  Until recently, these
syphilitic affections of the inner organs were little heeded
and even unsuspected.  And yet many deep-seated affections
of the liver, larynx, lungs, and even the heart and brain, are
enkindled by the syphilitic poison.
Professor Dittrich, of Erlangen, was the first who instituted
extensive inquiries into the syphilitic affections of the liver,
and communicated the results of his inquiries in the "Prager
Vierteljahrschrift."  According to his observations, the substance of the liver is never wholly, but only partially attacked
by the syphilitic process which consists in partially organized
exudations caused by inflammatory action. These inflammations are usually cured, only leaving cicatrices behind. Without giving any further account of the distinguished pathologico
anatomical investigations of the Professor, we will simply




CACHEXIA.                     175
state that the further progress of the disease in the liver
leads to suppuration of this organ.
Not only the liver, but also the spleen, kidneys and even
the thyroid  gland  are involved in  this process, which
ultimately leads to dropsy and death.  Such morbid alterations of parenchymatous organs constitute the remotest forms
of constitutional syphilis.
A syphilitic derangement of the liver announces itself in
the first place by jaundice, bloating of the liver, disposition
to diarrhoea and derangement of the digestive functions; afterwards the syphilitic cachexia which we shall describe more
completely hereafter, develope themselves.  It is undoubtedly
true, that the abuse of mercury aggravates the affections of
the liver. The process of exudation which is going on in
the liver, excites inflammations, swellings and sanguineous
engorgements of the liver, and, if the enveloping membranes
of the liver are inflamed, a dangerous local or general
peritonitis may ensue. A general syphilitic cachexia winds
up the malady. The skin becomes sallow, livid or yellowish.
The fat vanishes, the muscles grow thinner, the strength fails,
and even sight and hearing grow  weaker; the process of
sanguification  is  altered, and  a  state of anaemia and
hydroemia, with their consequences, such as dropsy, etc.,
set in. The blood-disks are less in number. These phenomena of a disturbed reproduction of the blood are accompanied by palpitation of the heart, murmurs in the arteries,
and chlorotic symptoms.  In some cases, intermittent or
remittent fevers, disposition to sanguineous extravasations
under the skin (scurvy, purpura hamorrhagica, etc.,) effusions
of blood into the lungs, bowels, interior of the bones;
atheromatous processes in the larger arteries and lastly
dropsy supervene.
Since his first communications, Professor Dittrich has published a new series of observations, and has added new
reasons for the confirmation of his views.
The cases which came under his notice, were divided by
him into three groups, the first of which confirmed the




176                TERTIARY SYPHILIS.
co-existence of an inflammatory process in the liver and loss
of substance of the vault of the palate and of the fauces.
The second group contained four cases without any apparent affection of the fauces, but with sufficient symptoms of a
syphilitic diathesis to permit one to ascribe the affection of
the liver to the previous action of the syphilitic virus.  He
likewise directs attention to the exudations into the substance
of the lungs, which were characterized by similar symptoms
as the exudations into the substance of the liver, whence the
Professor concludes that the pulmonary exudations are likewise of syphlilitic origin.
In the third group we have two cases where the exudative
process in the liver, and the transformation of the exuded
fluid into pus, still exist in their original form.  From the
fact that some portions of the liver are already cicatrized,
whilst new exudations are going on in other portions, the
Professor argues the chronic character of the exudation.
Ricord has shown with a good deal of accuracy that similar
morbid processes may be going on in the lungs. A considerable number of post-mortem examinations have led him to the
opinion that there are pulmonary affections which have to be
charged upon the presence of syphilitic tubercles. It is true
Ricord has arranged this morbid process side by side with
syphilitic tubercles or gummata of the outer skin.  These
adventitious growths run the same course in the lungs as in
any other portion of the body; the swelling has the same
form, runs the same course, and likewise terminates in suppuration.  The patients raise pus, the same as in-the last stage
of phthisis tuberculosa; they grow thin, feeble, and soon die
from this extreme derangement of the respiratory functions.
A development of the syphilitic tubercle may involve the
neighboring parts. For instance, if the palatine vault or the
Schneiderian membrane should be affected, the adjoining bones
and cartilages may become involved in the disorganization.
This may lead to syphilitic perichondritis and to syphilitic
laryngitis and syphilitic p'hthisis of the larynx. We have had
several cases of this destructive malady to treat.  Porter,




CACEEXIA.                     177
Hasse, Albers, Jansen and Rokitansky, all mention this disease, and Rokitansky moreover attributes it to the action of
mercury. According to Dittrich the laryngeal disease is not
a form of genuine primary perichondritis, but an affection that
first invades the soft parts, and gradually induces a syphilitic
stricture of the larynx (laryngosthenosis.) A portion of the
exudation or even the whole of it, changes to a fibrous, callous
growth, encroaching upon the internal space of the larynx.
Sometimes aportion of the exudation changes to pus, forming
ulcers of various shapes and dimensions.  If a deep-seated
portion of the exudation, which is in contact with the cartilage of the larynx, should change to pus, the destruction of
the cartilage and necrosis of this organ become unavoidable,
and abscesses round the laryngeal cartilages are the natural
result.
Ricord states that he saw tubercles in a heart, some of
which were about to soften.  Similar tubercles were seen in
the lungs of this same individual, and on the skin some of
the same kind of tubercles were already softened. There had
not been any symptoms of genuine tubercular phthisis in this
patient, previous to his contracting syphilis; it seemed, therefore, rational to attribute the presence of tubercles in his case
to the action of the syphilitic virus.
Accordingly Ricord advises whenever we have to deal with
inexplicable, deep seated, mysterious, disguised derangements
of the functions, and there is the least reason to suppose
that the trouble arises from syphilitic taint, to institute an
anti-syphilitic treatment.   He thinks that if this course
had been pursued, a pretty fair number of consumptive
patients might have been saved.
The following remedies either cure or palliate this disease:
Acid. nitr., Acid. phosph., Arsen., Alumina, Bryon.,
Carbo. animal., Carbo. veget., Calcar. carb., China, Chin.
sulph., Iodine, Kali carbon., Lactura vicosa, Lycopod.,
Mercur. viv., Mercur. sol., Mercur. dulc., Nux moschat.,
Plumb., Plumb. acet., Sabad., Secale, Sepia, Sulphur,
Thuja.




178                TERTIARY SYPHILIS.
[Particular indications for each of these remedies are of
course interesting and important, but the symptoms are so
various that it seems almost impossible to furnish a complete
list of the symptomatic characteristics to which each of these
remedies corresponds.  We will therefore content ourselves
with the principal outlines of each remedy, and refer the
reader to the symptomen-codex.
Acidum  nitricum: Signs of a general decomposition of
the fluids; scorbutic symptoms in the mouth; ptyalism;
foul ulcers of the gums and tongue; bleeding of the gums;
ulcerative soreness of the hairy scalp; falling off of the hair;
difficulty of hearing; humming and roaring in the ears;
ulceration of the nose with yellow  and fetid discharge;
ulcers in the throat with putrid smell from the mouth;
costiveness, with dampness and itching of the anus; scraping
sensation in the larynx with dryness and hoarseness, also
cough with expectoration of black coagulated blood; weakness of the extremities; soreness and lameness of the joints;
anxious dreams at night.; blotches and boils on the skin;
sallowness of the skin; spasms and epilepsy.
Phosphori adidum  may be used for symptoms similar
to the former, especially when there is a complication of
symptoms arising from loss of animal fluids, onanism; the
joints are more particularly involved; humid, itch-like eruptions on the forehead, face, back, thighs; inveterate ulcers
secreting a bad pus, with shaggy borders and a burning and
stinging pain; the lungs seem invaded by the syphilitic
process, with dry cough, also bloody cough.
Arsenicum: General sinking of strength; bloating, as if
dropsical; scaly; also malignant eruptions or ulcerations;
fetid diarrhoea, or exhausting bloody diarrhoeic stools with
constant and distressing urging; pale face; jaundiced color
of the skin; trembling of the limbs; arthritic and rheumatic
pains in the limbs diminished by moving the parts.
Carbo veget. may be used, if Arsenic. should not procure
the relief intended, and more particularly if symptoms of




CACHEXIA.                     179
dyspepsia, acidity of the stomach, palpitation of the heart,
are present. In such a case
Carbo animalis may be tried, instead of vegetabilis.
Iodine corresponds to glandular disorganizations, atrophied
conditions of the extremities, mercurial complications.
Mercurius sol. and dulcis: disorganizations of the tonsils,
ulceration of the throat, mouth, skin, bone-pains, especially
in bed, and more particularly about the skull, with excessive
painfulness of the hairy scalp; costiveness, dry, hard, and
lumpy stool, urine depositing a chalk-like and purulent sediment.
Plumbum acet: Melancholy mood, emaciation, debility,
anguish about the heart, flaccidity and paleness of the muscles,
hectic fever, ptyalism.
Sulphur: Itch-like eruptions, ulcers on the tibia, mercurial complications, ptyalism, bleeding of the gums, tumors in
the joints of the arms and feet.
Thuja: Syphilitic dyscrasia, characterized by condylomatous excrescenses with a broad base, discharging pus and
blood; pressure in the region of the bones, here and there,
accompanied by a pricking, scraping sensation; headache as
if a button were pressed against the skull.
For syphilitic perichondritis, the best remedies are: Belladonna, Hepar sulphuris, Drosera, Spongia, Causticum.
Drosera and Spongia are particularly adapted to a dry,
spasmodic cough, principally troublesome at night.
Kali bichromicum, if the cough is accompanied with ulcerative pains in the region of the larynx, and raising of pus from
the painful spot.
Causticum, when the weakness in the larynx is characterized by permanent hoarseness and weakness of speech.]




180           SYPHILIS OF LITTLE CHILDREN.
Syphilis of little Children.
Constitutional syphilis may be transmitted by the father or
mother to the fetus, but it is very rare that infants are infected
by the mother during the- passage of the child through -the
vagina.
In congenital syphilis the primary ulcers are wanting; however, the disease exercises considerable influence upon the
fetus in the uterus, and a large number of syphilitic mothers
either miscarry or their children are still-born. This is especially the case where both parents are affected by the disease.
The still-born infant exhibits all the traces of a deeply-rooted
syphilis.  Weakly children born at full term, or premature
children die either during or shortly after their expulsion from
the womb.  Many children tainted with congenital syphilis
seem to be robust and healthy at birth. A few days or weeks
elapse before syphilitic symptoms are perceived. But at the
expiration of two or three weeks, and in rare cases, of the second
month, the first signs of the disease make their appearance.
Children affected with congenital syphilis, are uneasy even
a few days after their birth; they cry day and night, emaciate
very rapidly, their face looks old and withered, and their
eyes are sunken.  Soon after there appear in the region of
the sexual organ, groins, on the thighs, heels, buttocks, round
the anus, and even in the umbilical region, and sometimes all
over the skin, circumscribed spots of a bright copper color,
rising speedily above the skin in the shape of blotches, and
sometimes running together, especially at the soles of the
feet, and covering them  entirely.  The same phenomenon
soon after developes itself on the palms of the hands. Simultaneously a papulous eruption, which afterwards changes to
small, dirty-yellow pustules surrounded with a broad areola,
breaks out on the chest, back, in the face, and on the hairy
scalp. On the inflamed portions of the feet, hands and anus,
tuberculous elevations start up, which become covered with
blisters resembling pemphigus; these blisters change to excoriations and afterwards to deep ulcers, particularly between




SYPHILIS OF LITTLE CHILDREN.           181
the toes, on the heels, in the inguinal folds, at the perinaeum
and in the axillae. At the anus ulcerated rhagades develope
themselves.
In spite of the characteristic nature of these phenomena,
mothers seldom pay much attention to them unless they should
have become quite serious. They generally look upon these
symptoms as common soreness, and employ such common domestic remedies as the nurse or some old woman may advise. Sometimes the eruption disappears without any medical treatment.
Frequently, however, superficial ulcers in the corners of-the
mouth and in the nose show themselves. The child is attacked
with a discharge from the nose which at first looks like catarrh.
Gradually the discharge increases, the conjunctiva and especially the margin of the eyes, the Meibomian glands become
inflamed and suppurate.  The ulcers in the corners of the
mouth penetrate more deeply, their edges become raised and
red. * The voice sounds hoarse, thin and moaning. Haemorrhage from the mouth and nose sets in; the latter is frequently
stopped up with crusts, by which the nursing is rendered
difficult; the breathing is accompanied by a slight rattling.
the'head breaks out, and some of the lymphatic glands swell.
Ulcers break out in the fauces, deglutition becomes painful,
the voice has a peculiar, hoarse sound. Such children seldom
live longer than one year, for the syphilitic disease becomes
complicated with acute tuberculosis of the brain. If the child
does not perish in this manner, the syphilitic cachexia developes itself.  The child becomes chlorotic, the skin assumes
a dirty gray-yellow color like wax, a complete state of anaemia
developes itself, the reproductive system is prostrate, and the
child dwindles down to a skeleton. Not unfrequently these
symptoms assume the form of scrophulosis, or chronic hydrocephalus developes itself. Congenital syphilis in children,
generally runs a very rapid course, and, unless speedily
arrested by proper treatment, terminates fatally.
If the infection dates from the passage of the child through
the vagina, or if it took place while the child was nursing-the
former is supposed to take place during slow labor-the




182           SYPHILIS OF LITTLE CHILDREN.
above-mentioned eruption is principally seen on parts where
the skin is delicate and deprived of the cheesy covering,
namely, the neck and the sexual parts; the course of this
form of the disease is the same as that of congenital syphilis.
Cazenave does not admit the possibility of congenital
syphilis. He points out the fact that there is perhaps not a
single well authenticated case of syphilis communicated to the
child during its passage through the vagina.  He believes,
however, in the possibility of syphilis being transmitted to a
child by the influence of the milk, and while at the breast.
Moreover, he thinks that the disease is much more frequently
inherited from the father than from the mother.
According to this same author, the syphilides of nurses are
exceedingly injurious to children.
In little children, affected with congenital syphilis, Wallace
has seen a peculiar cutaneous disease, of which no mention has
yet been made any where, and which he describes as follows:
There appear on various parts of the body, especially on
the back, isolated papulae of the size of peas and rather hard;
they remain unaltered for four or eight weeks, and then grow
gradually to the size of a bean, never larger. They are seated
in the sub-cutaneous cellular tissue, the skin over them is
moveable, and adheres to the eruption the more intimately
the larger it grows. After a while a number of these little
swellings change to abscesses which break in the middle,
discharging a thick, dark, bloody pus, and then becoming
covered with a blackish scurf, beneath which they heal very
soon.  The ulcerative process is accompanied with loss of
substance, and the cicatrices retain for a long time a hardness and a blue-red, livid color.
There are generally from  fifty to one hundred papulse
which break out at various periods, so that they exist upon
the skin in all their various stages. Some of them remain
small, others run the course just described, all are isolated.
There is no pain or fever; only if the skin remains inflamed
after the falling off of the scurf, some pain is experienced.
The patients were all less than a year old; the eruption




SYPHILIS OF LITTLE CHILDREN.             183
was accompanied by other syphilides, such as scales and pustules, and more particularly flat tubercles. Most of these
patients died in a state of cachexia.
Syphilis of little children has been investigated in Sweden
by a special board of physicians, with the following results:
1. There is no diagnostic sign by which a cutaneous disease, pustule or ulcer, when first showing itself on a nurse or
infant, could be traced to syphilis.
2. A syphilitic father may procreate a syphilitic child without infecting the mother.
3. We cannot as yet admit that a nurse's milk is alone
capable of infecting an infant with syphilis.
4. Nor can a nurse be infected by an infant tainted with
latent syphilis.
5. Secondary syphilis is less contagious than primary.
6. A child which is apparently healthy, when taken from
a syphilitic nurse and transferred to a sound one, may infect
the latter.
7. In case the life of the child should be jeopardized by
feeding, a physician would not be justified by the bare suspicion of syphilis in the child or nurse, in depriving it of the
nurse's milk.
8. No law should be enacted to prevent a nurse from voluntarily nursing an infant which she knows to be syphilitic.
9. In order to limit, if not to eradicate syphilis in foundling
hospitals, every infant should have its own nurse.
10. If a child, whose parents are altogether unknown, is
given to a nurse, she ought to be warned against the possible
danger of syphilis.
11. Sores on the breasts should be attended to with great
care, and, if possible, only such nurses should be engaged as
have had children at the breast for some time.
12. There is no precise period when the first signs of congenital syphilis first show themselves.
13. On account of the possibility of relapses, children
that have been cured of syphilis, should be carefully watched
for a year longer.




184           SYPHILIS OF, LITTLE CHILDREN.
In treating children for syphilis, it is above all of importance that they should not be exposed anylonger to the action
of the syphilitic virus. If the mother or nurse is infected
with syphilis, some other healthy nurse has to be selected.
Cleanliness, which is of the utmost importance in the case of
full grown syphilitic patients, is so much more important in
the case of little children.  These little patients should be
bathed every day, and kept in a uniform, somewhat more
elevated temperature. If these conditions are properly observed, the homoeopathic treatment of congenital syphilis
will be found much more efficacious than the allopathic.  In
most cases, a few doses of Mercurius sol. will be sufficient to
free the little patients of their sufferings, and to prevent all
consecutive disorders.  Only in very few cases it will be
found necessary to resort to other remedies.  If no cure
should be effected by a few doses of Mere. sol., Mercurius
prwecipitatus ruber., Mercurius dulcis., or Vivus may be tried.
If the child should improve in looks, the ulcers should heal
and the little patient gain flesh, we may safely conclude that
the syphilitic disease has been reached in its fundamental
principles, and if some symptoms should still remain lingering in the organism, we have to treat them in accordance
with the homoeopathic law, "similia similibus."  If circumstances should render it impossible to engage another nurse,
the sick mother or nurse has to be treated simultaneously
with the child, and the same remedies will have to be given.




HYDROCELE.                     185
SECOND SERIES.
Non-Syphilitic Diseases of the Sexual Organs.
The number of non-syphilitic diseases of the sexual organs
is likewise very great. They occur as frequently and are as
injurious to the organism as the syphilitic diseases. Not
only do they make terrible inroads upon both body and
mind, and even destroy them entirely; they deprive man of
the noblest function which God has appointed him to perform,
the pro-creation of offspring, and of the sweetest delights
which a man can enjoy, namely the delights of pure and true
love.
A great many derangements of the sexual organs arise
from depraved sensuality and from the horrible practice of
self-abuse to the pernicious consequences of which upon
body and mind we shall devote particular attention.  But
there are likewise other affections of these parts which owe
their origin to either causes, abnormal, social or constitutional
influences, an abnormal structure of the parts, and a variety
of other more or less evident circumstances.
We will first treat of the latter class of diseases, and afterwards of thosewhich are the natural consequences of sexual
abuse, together with the most appropriate treatment for their
removal.
Hydrocele.
By hydrocele we understand an effusion of serum into the
tunica vaginalis testis, and into the spermatic cord. The
tunica vaginalis of the testes and spermatic cord is a serous
membrane which, like other serous membranes, consists of
two layers between which a little serum is seated on its
inner surface.  This serous membrane  is always moist,
smooth, lubricated, owing to the serous fluid which is exhaled
13




186                     HYDROCELE.
by the blood vessels and absorbed again by the lymphatics.
If more serum'is secreted than is absorbed by the lymphatics,
it accumulates between the layers of the tunica vaginalis.
This excess of secretion is most frequently owing to sanguineous congestion and an inflammatory irritation of the
tunica vaginalis, and sometimes developes itself quite rapidly.
Hydrocele may occur at every age, even in new-born
children, but it is most frequent among the young.  The
most ordinary exciting causes are: constant riding on horseback, bruises, contusions, badly applied trusses, inflammations of the urethra and testicles.
The scrotum swells to the shape of a pear, generally on
one side; the swelling is elastic, and if percussed simultaneously on both sides, fluctuation is perceived in it. The lower
portion of the scrotum swells first; sooner or later the swelliag rises towards the inguinal ring.  The size of the swelling
varies, at first from  the size of a pear to that of a fist.
According as there is more or less serum in the tumor, it is
either soft and elastic, or hard and tense, so that it might
easily be confounded with sarcocele, which is very apt to
happen in hydrocele of long standing  where the tunica
vaginalis is considerably thicker than usual.
In some cases the swelling spreads as far as the middle of
the thighs and even the knees, and is distinctly seen through
the pantaloons.  The skin of the scrotum  remains unaltered
except that the blood-vessels become a little more prominent.
Hydrocele is not a painful disease, and what pain there is,
is generally slight, and caused by the pulling of the spermatic cord, and the pressure upon the testicle.
The safest diagnostic is the transparency of the swelling,
if, in a dark room, a light is held in front of it, and the
swelling is examined from behind.
The fluid which is contained in the swelling, is generally
clear, yellowish, frequently contains a number of crystals of
cholestearine, smells of semen, and consists of a quantity of
water, albumen, phosphates, sulphates, and muriates.  Less
frequently the fluid is turbid, green, brownish, or deep brown.




HYDROCELE.                     187
If the fluid is mixed up with a good deal of blood, the affection is termed hamatocele.
Of itself hydrocele is not a dangerous disease. Persons
may have it for years without feeling any pain.  But if the
swelling grows to a very large size, pains in the spermatic
cord and renal region may be experienced.  On account of
the enormous size of the swelling, the penis becomes very
short; sometimes it is entirely concealed, and sexual intercourse becomes impossible.  The discharge of urine is interfered with, and the emission of semen is likewise impeded.
Hydrocele of young people, if of recent origin, may be
cured by the following remedies:
Calcarea carb., Coniumz, Digitalis, Dulcamara, Mlercurius
sol., Spongia, Staphys.
[Of these remedies Calcarea and Spongia may be principally used, when there seems to be a scrofulous taint pervading the constitution, and the reproductive system is depressed,
as indicated by loss of appetite, debility, emaciation, dryness
of the skin.' Conium is particularly suitable when the affection can be
traced to mechanical injuries, contusions, etc.
Dulcamara, when it arises from  a cold, suppression of
tetters, suppression of momentary or habitual sweat by exposure to a draught of air, dampness, etc.
Mercurius sol., if the patient had been troubled, when a
little child, with soreness and swelling of the sexual organs,
especially of the prepuce, if he is liable to feeling chilly and
taking cold during damp weather, with sore throat worse
during empty deglutition; if the hair is dry, falls out, the
patient is troubled with sour-smelling night-sweats, costiveness, the alvine evacuations being hard, dark-colored, lumpy.
Digitalis may prove useful if there is a constant desire to
pass water, or if the patient had had water in the brain when
a child.]
In the case of little children we may use Pulsatilla and
Rhus tox. in the commencement of the disease, and afterwards Carbo veg., ara1p., Helleb. and Iodine.




188                    VARICOCELE.
[Graphites is particularly useful in such cases.  Iodine is
adapted to a general scrofulous taint, characterized by glandular swellings, emaciation. Helleborus when the child. had
had water on the brain, or dropsy after scarlet fever.]
In the case of plethoric individuals, we may have to use
Arsenic, China, Ignatia or.TNux vomica; (Arsenic more
particularly if the glans penis is inflamed and swollen, and
Nux vomica if the patient has a ravenous desire for meat,
bowels are costive, and the patient is troubled with piles, and
has an irritable disposition.)  If the disease is of long standing, or very extensive, we may try Ferrum, Silicea, Sulphur
and Zincum.  In old people, where absorption has become
impossible, tapping, or even extirpation may have to be
resorted to.
Varicocele, Cirsocele.
By varicocele we mean a morbid dilatation of the veins of
the spermatic cords and testicles.
The causes of this somewhat frequent disease are, in some
respects anatomical, inasmuch as the veins of the spermatic
cords form long sinuosities, and are so arranged that blood
has overcome its own gravitation, which is rendered still more
difficult by the absence of valves in the veins.  Persons who
are naturally disposed to varices and piles, are liable to
varicocele. Beside these mechanical causes, the disease may
likewise be caused by excessive sexual intercourse, and by
onanism, owing to the permanently increasing congestion
which these practices determine to the sexual organs. Habitual costiveness becomes a mechanical cause of this disease, in
consequence of the reflux of the venous blood being impeded
by the hard faeces which are lodged in the lower portion of
the colon.  This explains the fact why the disease occurs
more frequently on the left side, where the left spermatic
vein passes under the last portion of the colon. In a similar
manner a tumor in and on the abdomen, or a large hernia of
long standing, may produce varicocele by pressure upon the
spermatic cord. Constant riding on horseback, and continual




VARICOCELE.                    189
standing during work, likewise favor the development of the
disease.  Badly applied trusses, venous congestions of the
abdomen, or of the portal system, swelling of the liver will
sometimes cause the disease.  A varicocele of considerable
size, which involves the inguinal canal, may be mistaken for
scrotal hernia. Its slow disappearance in a horizontal, and
its equally slow return in an upright position constitute characteristic differences between the two diseases.
Varicocele is characterised by the following phenomena:
A soft, knotty and elastic swelling extends from the scrotum
to the inguinal ring; the nodosities readily disappear under
pressure, but reappear again as rapidly. The scrotum hangs
down relaxed; the affected side is longer; the more the disease progresses, the longer and the more relaxed becomes the
scrotum.  The swelling decreases in a recumbent posture, it
increases after standing and walking, hence the swelling generally reaches its largest size in. the evening.  On pressing
upon the scrotum, a sensation as of a bundle of worms is
experienced. The pains are, upon the whole, not very considerable; at times dull pains in the loins and kidneys, a
feeling of heaviness, malaise, drawing in the spermatic cord
and testicles; shooting, colicky stitches are occasionally
experienced in these regions, especially when the sexual desire
is excited without an opportunity being given of gratifying
it.  Such shooting stitches are generally experienced when
dallying with a handsome woman.  The patients feel easier
by supporting the scrotum with the hand. On the inner side
of the thigh which is in contact with the diseased testicle,
the patients generally perspire a good deal; the sweat which
is generally of a corrosive character, frequently causes a
troublesome eczema on the scrotum  and thigh, sometimes
spreading to the perinoeum  and anus.  The affection never
endangers life, but is troublesome and wears upon the spirits.
At times the pains become more acute, strike to the renal
region and thighs; walking is impeded. These disagreeable
sensations in the sexual parts cause depression of spirits,
fretfulness, and hypochondria. The patients are continually




190                    VARICOCELE.
haunted by the idea of being affected by an incurable malady,
are frequently driven to suicide by such thoughts.
As we have said, the disease is not dangerous to life, nor
is the sexual power necessarily affected by it. Nevertheless,
if the spirit should be much affected, and the disease should
have attained a high degree of development, the treatment
will have to be conducted with care and energy.
Lighter cases of this disease may yield to cold hip-baths,
suspensaries, and to the abstaining from all influences which
have a tendency to promote a congestion of blood to the
parts, such as: sexual intercourse, riding on horseback,
dancing, constant walking or standing, warm baths,,etc. For
the depression of spirits we may use: Belladonna, Calc. carb.,
Caustic., Conium, Lyeopod., Pulsat., Sepia, Tart. stib.,
Veratrum.
Varicocele of the labia majora is of less frequent occurrence. It is less troublesome than varicocele of the scrotum,
and generally yields to a few doses of Lycopodium.
[The medicines may be used in the following order:
Belladonna, if the patient suffers with symptoms of congestion in other parts, especially in the head, and the swelling
feels hot, hard, with stitching and throbbing pains.
Calcarea carb., may be given in alternation with, or after
Belladonna, especially if the sexual instinct is very much
excited, the skin and hair are dry, the bowels are costive.
Lycopodium and Sepia may be used in the place of Calcarea, if the sexual desire is depressed and the sexual power
is likewise very weak.
Pulsatilla is particularly suited to individuals of a plegmatic, melancholy disposition, and who are subject to gastric
derangements, mucous diarrhoea, bad taste in the mouth, etc.,
in recent cases.
Aconite will be found eminently useful in raising the
nervous energies of the affected part, and dispelling the engorgement of the vessels.]




MENSTRUATION.                    191
Derangements of the Menstrual Functions.
Menstruation is an exclusive function of the sexual organs
of the human female, and a regular recurrence of this phenomenon is of great importance to a healthful condition of
her sexual powers. Derangements, irregularities or suppressions of the menstrual functions are frequently the cause of
many diseases of the uterine system, and even of sterility.
The appearance of the menses, together with other changes
in the female organism, is a sign that the sexual system of
the female is maturely developed. In one climate the average
appearance of the menses is about the fifteenth year, and
their cessation from the forty-fifth to the fiftieth. In warm
climates, among the inhabitants of the southern region, the
menses both appear and and cease at an earlier period. The
appearance of the menses is hastened by the woman's mode
of life, her morals, the use of highly seasoned food, and premature sexual intercourse. If the menses are regular, they
ought' to reappear every four weeks. In a state of health,
they last four days, sometimes from five to eight days. As a
general rule, the menses do not flow during pregnancy and
while the woman is nursing; in a very few cases, however, the
menses were known to have continued during pregnancy.
This monthly discharge of blood, which is necessary to a
healthy female, is subject to frequent derangements and
irregularities which require an appropriate medical treatment.
The menses are frequently preceded or accompanied by pains
in the sacral region and abdomen, drawing in the thighs,
stitches in the breasts, headache, vomiting and other nervous
symptoms.  During the menstrual flow the woman is generally paler than usual, tired, not disposed to work; the eyes
are somewhat sunken, surrounded by blue margins.  Such
symptoms are of no importance, and do not require the interference of art; as soon as the menses cease, the woman's
spirits become brighter, and the desire for sexual intercourse
is restored.




192                   AMENORRHCEA.
Suppression of the menses at a period when they ought to
flow with regularity, is a morbid condition of the organism,
termed amenorrhoea.
This condition is characterised by a variety of troublesome
symptoms. About the period when the menses ought to flow,
the patients frequently complain of violent pains in the small
of the back and loins, drawing and heaviness in the feet, more
frequent urging to urinate, malaise in the abdomen, irritable
mood, and hysteric spasms.  Signs of congestion in other
organs are frequently present, such as headache, vertigo,
buzzing in the ears or oppression of the chest, spitting of
blood, palpitation of the heart, cramps in the stomach, vomiting, etc. Even convulsions may set in; in the more favorable
cases the nose bleeds. Between these periodical paroxysms,
symptoms of plethora are frequently present, the patients
feel heavy, weary, their sleep is uneasy.  In many cases
chlorotic symptoms gradually develope themselves and may
even terminate in dropsy.
In amenorrhcea the menses are retained from the first; an
accidental suppression of the menses after they had made
their appearance, is termed menoschesis.
The menstrual suppressions may either be complete, where
there is no flow at all, or only partial, with scanty discharge.
The menstrual flow may be suddenly arrested by violent
emotions, such as fright, anger; exposure of the feet, chest or
sexual parts to dampness, a draught of air, keen winds;
immoderate dancing; leaving off a portion of the underclothes; suppression of sweat on the feet; coit during the
menses; fever and other acute diseases.
Scanty menstruation occurs in chlorotic females, affected
with leucorrhoea, or after considerable losses of the animal
fluids, after severe diseases, puerperal fevers, or in consequence of deficient care and food. It has often been observed
that women of the age of thirty or forty suddenly gain flesh,
whereas, at the same time, the menses flow more scantily, and
even sterility sets in. Diseases of the uterus, ovaries and




DYSMENORRIKEA.                   193
vagina may induce scanty menstruation or a complete suppression of the menstrual flow.
Suppressed or scanty menstruation is generally accompanied by congestions, hoemorrhages from the nose, mouth,
stomach, bowels, lungs, bladder, rectum, skin, breasts, or
from existing ulcers. The nervous system is likewise affected,
and we have hysteria, epilepsy, corea, catalepsy, spinal irrita.
tion, cardialgia, neuralgia, somnambulism, mental derangements, paralysis, etc. Disorganizations leading to consumption, hectic fever and dropsy may likewise set in.
In investigating the causes of menstrual suppression, we
have to pay particular attention to the probable existence of
pregnancy.  The general phenomena, such as nausea, vomiting, nervous derangements, congestions, etc., are very much
alike in both conditions; the abdomen may even bloat considerably. Some women, especially when young, and recently
married, mistake the symptoms of amenorrhcea for pregnancy.
Dysmenorrhoea is another form of menstrual irregularity.
It is a fow of the menses accompanied with much distress.
The discharge is not suppressed, but sometimes preceded for
several days; and accompanied by acute distress.
Sometimes the flow  is excessively copious, and almost
resembles hbemorrhage.  General debility, anaemia, dropsy
and sterility may arise from such a state.
For amenorrhoea the following remedies will be found most
suitable:
Baryt. carb., Belladonna, Calear. carbon., Causticum,
Cocculus, Conium, Dulcamn., Kali. carb., Lycop., Magnes.
mur., Mlercur. sol., Mezer., Natr. mur.,.Pulsat., Sepia,
Spongia, Staphys.
For menstrual suppression we give: Arsen. alb., Alum.,
Con., Coccul., Ferrum, Ignat., Garaphit., Natr. mur.,, Nux.
vom., Platin., Plumb., Opium, Sepia, Sulphur.
In dysmenorrhcea the following medicines have proved
efficacious:
Acon., Antim. crud., Au, umr., Bellad., Calc. carb., Carbo.




194                  MENSTRUATION.
veg., Coccul., Conium, China, Graphit., Ipec., Iodine,
Magnes. carb., Natrum, Natrum  mur., Nux mosch., Phosphor., Pulsat., Stramon., Sulphur, Veratr.
I have derived particular benefit from the alternate use of
China and Nux vom,
In menorrhagia or excessive menstruation, I have given
with great success:
Acid. nitr., Aeon., Arnic., Arsen., Bellad., Chamom.,
China, Crocus, Coccul., ierrum, Ignat., Nux vom., Platina,
Sepia, Silicea, and Sulphur.
[For the benefit of the reader we give the following symptomatic indications of the principal remedies in this list:
Aconite is a great remedy for menstrual suppression in
consequence of fright, exposure to wet or a draught of air,
with soreness all over, and particularly in the lower part of
the abdomen; oppression on the chest, palpitation of the
heart, headache, dizziness, buzzing in the ears; also for
metrorrhagia, with burning sensation in the womb, the blood
is bright-red, the flow is accompanied with chills and gushes
of heat, fainting feeling, throbbing in the whole body, heaviness of the lower limbs.
Cocculus: Premature menses, with distension of the abdomen, contractive cutting in the abdomen at every movement
and when drawing breath, sharp pressure as from stones in
the distended abdomen when sitting or moving, painfulness of
the distended abdomen as from an ulcer; amenorrhoea with
abdominal spasms, flatulence, lameness, anguish, oppression
of breathing, spasms in the chest, nausea with fainting sensation; painful menstruation with copious discharge of coagula
and subsequent haemorrhoids; suppression or irregularity of
the menses, with uterine spasms.
Arsenicum: Painful menstruation, with lancinations from
the rectum to the anus and pudendum, or from the pit of the
stomach to the hypogastrium, weeping and moaning.
Ignatia: Scanty menstruation, with black blood, having
a putrid odor.
Magnesia muriatica: Profuse menstruation, with pain in




MENSTRUATION.                    195
the small of the back and thighs, also spasms in the ligaments
of the uterus.
Nux vomica: Premature menses, more scanty than usual,
also with nausea, chilliness and fainting, which is sometimes
preceded by spasmodic movements in the abdomen, and followed by a sense of chilliness on rising from bed; painful
menstruation, with contractive uterine spasms, a griping and
digging sensation, with discharge of clots of coagulated blood.
Ipecacuanha, in metrorrhagia, with nausea, faint feeling;
also, after miscarriage.
Pulsatilla, Amennorrhoea caused by a cold, with pale face,
spasmodic tightness in the chest after the slightest emotion,
chilliness even in summer; amenorrhoea with leucorrhoea,
vertigo, throbbing headache, fulness and pressure in the
stomach, drawing, aching pain in the uterus, painful micturition; painful menstruation, with cutting in the abdomen and
uterus, pressure on the bladder, loss of appetite, discharge of
black and viscous blood: painful menstruation, preceded and
accompanied by pleuritic stitches, which are excited by moving
the arms, drawing breath, and by loud talking, and laming
the arm; menstruation, with thick and black blood, discharged by fits and starts.
Sepia, premature menses, with scanty flow, leucorrhcea
with stitches in the uterus, and itching in the vagina.
Sulphur is indicated, for similar conditions as Sepia,
especially if the menstrual blood is thick, black, and so acrid
that it renders the thigh sore.
Platina will be found serviceable for excessive menstruation, with pressing from the groins to the genital organs,
and spasmodic labor-like pains in the abdomen; dark blood,
which is partly fluid and partly coagulated; metrorrhagia,
with sexual orgasm and desire for an embrace; also, with
thirst, anorexia, sensation as if a ball were moving about in
the abdomen, pressing pains in the groins; also, with sensation as if the body were growing larger in every direction.
Crocus, metrorrhagia, the blood being dark and coagulated.
Sabina, metrorrhagia, with bright red arterial blood.




196                    SELF-ABUSE.
China, metrorrhagia, with drawing in the lower abdomen
and thighs, sense of debility, bearing down pains in the
womb, sallow complexion, dizziness, chilliness, stretching of
the limbs.
Secale cornutum, metrorrhagia with bearing down pains,
resembling labor-pains.]
There is one remedial agent which has helped me out in the
most obstinate and inveterate cases of amenorrhoea, where
every other means had failed. This agent is electro-magnetism, which I have found to be one of the most efficient means
in many diseases of the sexual organs, and concerning which,
I offer more extensive remarks at the conclusion of the chapter on the consequences of sexual excesses.
I have treated many cases of amenorrhoea, accompanied
with considerable derangements of the sexual sphere, and of
the organism  generally. These patients had been under
allopathic and hydropathic treatment, but without any success.  Homeeopathic treatment seemed likewise inefficient,
and the application of electro-magnetism was the only means
by which the menses could be brought on, sometimes after
a few applications only.  The organism was restored to its
normal condition, the sexual desire became again active, the
patients looked better, and were enabled to enjoy the exquisite delight of bringing forth healthy and strong children.
In applying the apparatus, I introduced one of the poles
into the vagina, and applied the other pole to the small of
the back. At first, I allowed the electric current to continue
for two minutes pnly, and then added one minute at every
sitting, until the application lasted fifteen minutes, after
which the menses soon made their appearance.
On Self-Abuse.
THE desire to propagate the species, is one of the most
sacred instincts of the human heart. This instinct, which
begins to be felt about the period of pubescence, first
announces itself by a mysteriously magnetic attraction of
the senses towards each other.  This attractive force is




SEXUAL EXCESSES.                  197
sexual love, which, as it progresses, develops sexual desire.
This precious gift, which is one of the first means of promoting health and cheerfulness of mind, may, on the other
hand, be so abused, as to destroy the organism, and become
a source of torture and misery.
The perverse genius of man, misguided by sensuality, has
been led to the most pernicious abuses of the sexual appetite,
and to the most revolting refinements of sexual lust.
These sexual excesses undermine health, shorten life,
destroy the happiness of families, incapacitate the male from
the noble office of procreating offspring, and deprive woman
of her beautiful mission of bearing children.
Believing with Jean Jacques Rousseau, Aontaigne, Kampe,
Jean Paul and others, that a knowledge of the devastating
effects of vice is calculated to excite an aversion to vicious
habits, and that many may be saved from destruction, who,
without this knowledge, would lose bodily strength, mental
vigor and contentment, by the odious practice of self-pollution: we feel called upon to devote a chapter to this interesting subject. We will first depict the frightful effects of sexual
excesses, and afterwards endeavor to explain the means by
which they may either be removed or alleviated.
Sexual Excesses.
Sexual excesses are almost as ancient as the human race.
Man has, at all times, and among all nations, been given to
refinements of sexual lust. It seems, however, as though the
ancient races had been more corrupt in this respect than the
modern. All such horrible violations of nature as pederasty,
sodomism, etc., are much less frequent among us than they
were among the ancient Greeks, Romans, and the Orientals.
Even the bible furnishes records of the sensuality of the
Asiatic and African nations.  Suffice it to mention the, vices
of Sodom  and Gomorrha, the excesses of Ruben, Juda, and
of Thomar, who may be set down as the mother of prostitutes; of Potiphar, Absolom, and even of the wise Solomon
who kept a harem of a thousand women.




198                 SEXUAL EXCESSES.
The ancient Egyptians were celebrated for their sexual
excesses.  The Lesbian love, which led to the extirpation of
the clitoris, a practice which is still prevalent in modern
Egypt, for the purpose of arresting this abuse, emanates
from this region. In our article on Lesbian love, we will be
more explicit on this point. According to Herodotus, the
pyramid of Cheops was constructed by the lovers of the
daughter of this king, as a reward for her favors. Of the
wild excesses of Cleopatra whole volumes might be filled.
The temple of Isis in Egypt was the central locality of all
the excesses of the priests.
The ancient Babylonians, Medes, and Lydians were celebrated for their debauched manners, but the licentiousness of
the Persian kings beats every thing that history has recorded
in the shape of human immorality. The most beautiful and
most fascinating girls were sent to the Persian kings from
every province of their vast empire. These girls had to
anoint themselves for twelve months with salves, balsams, and
myrtle, before they could be admitted to the honor of sharing
a nightly debauch with their master. Even their own daughters and sisters became the concubines of the Persian kings.
There was a law in Babylon which obliged every maiden in
the country to expose herself to a stranger, once in her lifetime,
in the temple of Venus. The women of Carthage and Tyrus
had to submit to a similar prostitution, and the money which
they earned by this degradation, was their wedding-present.
The women of Lydia obtained their bridal gift by" similar
means, and the women of Armenia were not deemed fit to be
married until they had been prostituted by some stranger in
the temple of Diana Anaitis.  In the temple of Belus at
Babylon, at Thebes in Egypt, and at Patares in Lydia, it was
the gods, or rather the priests, who honored the young maiden
with their favor, and there are yet devotees in Egypt, to whom
women expose themselves in public, in the belief that their
conduct is well-pleasing to God.
We are well acquainted with the debaucheries to which the
Greeks and Romans were addicted at the perifod when these




SEXUAL EXCESSES.                  199
nations had fallen from their high estate. Who has not heard
of those bacchanalia during which young girls, in a state of
intoxication, and singing amorous songs, half naked and
dishevelled, committed the most horrible orgies with the men
disguised as satyrs and shamelessly exposed?
Sappho rendered herself famous, not only by her songs,
but also by her amorous excesses, and by the Lesbian vice
which she helped to spread. The prostitute and public dancer
Collytto, was worshipped in Athens as a goddess, under the
name of Venus popularis.  She was honored by nightly
orgies under the direction of her priests.
Public depravity was still worse in ancient Rome. Caesar
bargained away his virtue to ^TNicomedes, king of Bythinia,
who was designated as " the husband of "all women, and as
the wife of all men." Augustus was guilty of the blackest
crimes, and the poet Ovidius was banished from the court of
Rome for no other reason than because he had surprised the
emperor in the act of committing incest with his own daughter.
Every Roman lady, married or unmarried, sought the honor
of a debauch with the emperor.  They had first to undress
themselves, in order to have all their secret charms or defects
examined, before they could be admitted to the imperial favor.
Caligula, whom nature, according to Seneca's own statement,
had destined to show to the world what a monster on a throne
is capable of doing, committed incest with all his sisters, even
in the presence of his wife, and while eating his meal.  He
took off the married women in the presence of their husbands,
and, after having exposed them in public, used any of them he
took a fancy to.  His palace was a brothel, where the most'
horrible vices were committed. He boasted of being the king
of vice, and the most infamous excesses are charged upon him
and his companions.
Messaline, wife of the imbecile Claudius, surpassed every
woman of her time in vile licentiousness. Juvenal says of
her: " Dressed in vile clothes, she entered her chamber in a
public brothel, and, under the name of Lyciska, exposed
her body that had borne the magnanimous Britannicus;




200                SEXUAL EXCESSES.
she was the last to leave the house in the morning, not satiated
bu't wearied."
Nero went even so far as to violate the person of a
vestal, a crime which the superstitious Romans would not'forgive their emperor Heliogabalus.
The purifying influence of christianity arrested for some
centuries theses excesses, but after this period lost all power
of restraining the lusts of either rich or poor, laymen or
priests.  Monks and nuns were as much addicted to debauchery as the Greeks and Romans had been, so that Charlemagne was obliged to issue the following edict:
"We have been informed, to our great horror, that many
monks are addicted to debauchery and all sorts of vile abominations, even to unnatural sins. We forbid all such practices
in the most solemn manner, and hereby make known that all
monks who indulge in the gratification of such lusts, will be
punished by us so severely that no christian will ever care to
commit such sins again. We command our monks to cease
swarming about the country, and we forbid our nuns to practice fornication and intoxication. We shall not allow them
any longer to be whores, thieves, murderers and so-forth, to
spend their time in debauchery and sing improper songs.
Priests are herewith forbidden to haunt the taverns and
market-places for the purpose of -seducing mothers and
daughters, etc."
This account of sexual excesses might be continued down
to our time, but it is useless to dwell upon such statistics any
further.  The facts which we have related, are sufficient to
show that such excesses have prevailed among all nations and
at all ages and have been a prolific source of the physical
and moral deterioration of our race.
Among the specific forms of a depraved sexual appetite
we distinguish pederasty, the Lesbian love and sodomy; these
abominations are, fortunately, rarely indulged in among
modern nations; but there is one vice which is universally
prevalent now-a-days, and to which we shall devote a good
deal of attention, it is the vice of self-abuse or onanism.




SEXUAL EXCESSES.                   201
Pederasty. This vice, horrible as it is, was practised even
by the most ancient people.  Among the Hebrews, whole
cities were addicted to it. It is believed that Sodom and
Gomorrah were destroyed by fire and brimstone as a punishment for this abominable practice. In Greece pederasty was
a religious art, and the most distinguished men, even Socrates,
whose minds soared far above the common ideas and habits
of the race, are said to have practised this vice. Greece,
Syria, Egypt, and the north of Africa and Asia, are known
as countries where sodomy is a native vice. Prisoners of the
Egyptian musulmans, bedouins or maures, have to submit to
the infamous familiarities of their captors.  In all those
countries of Asia where Bramah is worshipped, there exists
a class of young men who make it their business to sell themselves for such horrible purposes.  Among the Christian
nations of modern times the vice of pederasty has become
nearly extinct. In the middle ages it prevailed to a considerable extent among the Catholic priests; even Leo X and
Sixtus IV. were suspected of indulging in it.  Among us
pederasty is a capital crime, like murder; in 1750, two
pederasts were publicly burnt in Paris. In the larger capitals
of Europe some refined rake may yet now and then be found
anxious to buy the favors of a few handsome young reprobates
who are generally unacquainted with the evil consequences of
this practice, such as fistulae, induration and ulceration of the
rectum, and in whom the last whisperings of an outraged
conscience are stifled by their horrible depravity.
The so-termed Lesbian love is a vice of a still more hideous
and degrading nature than pederasty.  If it be a horrible
practice for men to gratify their lust in filthy embraces, how
much more disgusting is it to see women approach each other
for the purpose of quieting their wild desires by the most
unnatural intimacy.  It seems as though sexual depravity
could scarcely reach a lower level.
This vice has derived its name from the island of Lesbos,
where it was practised by the celebrated poetess Sappho.' In
14




202                SEXUAL EXCESSES.
ancient Rome, it was likewise common; and women who indulged in it, were called by the Romans "Tribades."
Previous to the first French revolution, there existed-a
society of women in Paris, who numbered some of the first
ladies of the city among their number, and who made it their
business to practice this vice in common. As if to add
mockery to their infamy, they termed themselves.the society
of the " vestals."
Sodomy was originally practiced by shepherds, who resorted
to this mode of gratifying their sexual passion with beasts,
fpr want of more natural opportunities. Even at this day,
sodomy is still practiced in Sicily, with goats. According to
Blumenbach, the women of Guinea have intercourse with
monkeys, and the Persians resort to she-asses as a cure for
coxalgia.
Self-Abuse, and its Consequences.
Onanism, or self-abuse, is a most pernicious vice, and a
deplorable substitute for a natural gratification of the sexual
passion.
According to the bible this vice was first practiced by
Onan, from whom it is named; but the Greeks and Romans
attribute it to the artful Mercury, who invented it for the
benefit of Pan, who had lost his mistress, the beautiful Echo.
It is an unfortunate fact that this vice can be traced to the
remotest antiquity, and that it has been practiced by the
lowest as well as by the highest classes of society. It is a
most unnatural vice, resulting in extinction of the conjugal
faculty, demoralization, and weakness of the sexual powers.
The effects of this vice are the more pernicious the sooner
it is practiced. In our generation it is known even to tender
childhood.  Thousands are initiated in such practices by
servants and nurses.  In public and private schools it is
universally prevalent.  How important it is, therefore, for
parents and teachers, to watch the private conduct of their
pupils.




SEXUAL EXCESSES.                  203
The consequences of this vice differ more or less according
to the age and sex of the patient.
Previous to the age of pubescence, the effects in both sexes
are pretty nearly alike: momentary excitement, followed by
depression of spirits, and finally by a morY' or less complete
derangement of the nervous functions.
The following is a tolerably accurate picture of the gradual
effects of this vice: After having indulged in this practice
for a time, repeating it more and more frequently until it
becomes a daily habit, the child, without being otherwise sick,
loses its bright complexion, which becomes pale, with a greenish tint, especially around the eyes, which are sunken, surrounded by blue margins; the lips lose their vermillion hue.
Careful observation reveals to us other important signs of the
alteration of the child's health.  The mind is indolent, the
child sits with the head inclined forward, staring as if absorbed
in deep thoughts, without, however, looking at any thing, and
started by a sudden question. If told to do a thing, the child
rises slowly from its seat, and all its motions are slow and
heavy. It is averse to play, which it loved formerly, prefers
sitting quiet and alone, becomes obstinate, peevish, irritable,
and cannot bear the least joke. Children who are addicted to
such habits, like to be in solitary places, where'they can indulge their vicious propensities; they like to sleep late in the
morning, and nevertheless feel unrefreshed and heavy on getting up. Gradually every function, especially digestion, suffers
more or less. The tongue and teeth are covered with phlegm,
the least nourishment causes distress, colic, oppression, flatulence. The child grows thin, and the mental faculties are
weakened.  The power of comprehension is diminished, the
child is dull and taciturn, though unconsciously so. Such consequences may continue for years, to the end of life, even though
the practice of this vice had long been abandoned, and everythiig had been done to restore the patient's health. If some
kind of sickness should set in at this time, it is generally very
severe; the least fever is apt to assume a typhoid form, and the
exhausted body speedily succumbs to the ravages of disease.




204                 SEXUAL EXCESSES.
Sadly does the young life perish even before it had begun
to bud, as a young plant withers away at whose root a worm
had been gnawing.  All the cares of sorrowing parents are
fruitless, the sources of their highest terrestrial happiness
are drained, and the' state is deprived of useful and healthy
citizens.
From this short but true picture we may infer that there
is no more degrading bondage than the bondage of one's own
lusts. The imagination is enkindled by an impure fire. It is
in vain that the patient tries to resist the power of habitual vice;
it torments him in his dreams, and in his waking hours. And,
instead of enjoyment, it gives him disappointment and misery.
Self-abuse is the most certain road to the grave. It not only
destroys the body, but likewise undermines the peace of the
soul; the destruction is not accomplished all at once; slowly,
but most certainly, the onanist instils a poison into his frame
that will inevitably lead to death.
If this vicious habit is continued beyond the age of pubescence, the fountain of health is drained forever. The mind
is weakened, the memory gone, the ideas become confused,
and the patients frequently are seized with mania; they are
constantly restless, tormented by anguish and remorse, and
driven to tears; they are subject to frequent attacks of
vertigo; their senses, especially sight and hearing, are weakened; their sleep, provided it has not entirely left them, is
interrupted by uneasy dreams. The body is exhausted, its
growth is checked, the patients are tormented by violent pain,
such as headache, pains in the chest, pressure at the stomach,
colic; all complain of an indescribable lassitude in the limbs.
The face is covered with itching pimples, pustules on the nose,
dhest, thighs. The sexual organs suffer a good deal; some
lose all power of erection; others lose their semen from the
least excitement, or even at stool, while bearing down. Others,
again, are afflicted with a constant flow of semen, termed spermatorrhcea. Robust persons are sometimes troubled with very
painful erections. Some lose their urine involuntarily, others
are attacked with a most painful retention of urine, or with




SEXUAL EXCESSES.                  205
violent burning at urinating. Many are attacked with swellings
of the testicles, pains in the penis and spermatic cord. Most
of these unfortunates are impotent, either because they are no
longer capable of erections, or because the semen has lost all its
vivifying properties.  The functional derangements caused in
other organs, will be mentioned more particularly in the sequel.
In women the consequences of onanism  are somewhat
different from  what they are in men.  The object of this
vicious habit is the same in boys as well as in girls, viz.:
sexual excitement.  There is this difference, that girls do not
weaken themselves by the, loss of the spermatic fluid, but by
the excessive exaltation of the nervous system.  Nervous
prostration is therefore the first effect of. onanism in young
females, and is characterized by headache, depression of
spirits, obstinacy, sadness, indifference to worldly pleasures,
and finally, melancholy and other forms of mental derangement.  The senses become duller, especially the eyes, which
are red and dim, with a staring look.
In the hospitals and lunatic asylums, there is a larger
number of females than males, under treatment for onanism.
This is an additional proof, that in the female, the mind and
nervous system are principally affected by onanism.
This nervous derangement soon leads to a derangement of
the digestive system. The patients grow thin. All sorts of
spasmodic symptoms develope themselves, such as spasms,
cardialgia, chorea, epilepsy, catalepsy, convulsions, etc. All
the former charms of the young woman leave her, her face
looks sallow and thin, the skin is rough, dry, cracked, covered
with freckles and pimples; the eyes look dim, the lips are
pale and bluish, the teeth decay. A copious mucus is discharged from the vagina, corroding the thighs, groins, and
perinaeum, and causing a most distressing hysteria. The
internal organs become diseased, indurations and cancer of
the womb develope themselves, and the patients either die of
some such disease, or else pine away from debility.
Nevertheless, howsoever horrid the consequences of onanism seem, they may be prevented or removed by appropriate




206                 SEXUAL EXCESSES.
and timely treatment. By and bye we shall explain in detail,
the means which we employ for this purpose. We will first
advert to the pernicious consequences of excessive sexual
intercourse, which are indeed less ruinous than the effects of
onanism, but are likewise destructive of health.
My readers will naturally inquire, At what age, and how
often, is it proper to indulge, without injuring one's health?
It is not very easy to answer this question, but we will
nevertheless attempt it.
As regards age, it is undeniable that sexual intercourse
ought not to be indulged in before the organism is fully developed, or the period of pubescence has been reached.
This may depend upon climate, geographical position, mode
of life, food, race, temperament. All these causes may either
hasten or retard the period of pubescence.
In the countries between the tropics, females attain their
maturity much sooner than they do in the frigid or temperate
zones.  Some are known to have borne children at the age
of 13 or 14, and at the age of 30 the menstrual functions
cease.  In the countries of the temperate zones, pubescence
is reached by females at the age of 14, and by males at the
age of 17 or 18.  A few more years are required to enable
them to reproduce their species.
In former times all premature marriages were forbidden by
law. Lycurgus forbade men to marry before the age of 37,
and women before the age of 17. According to Xenophon
and Plutarch these laws were enacted for the purpose of
raising a vigorous race. Aristotle required the husband to
be 20 years older than his wife, in order that their fecundating powers might cease at the same period.  Among the old
Germans no man was allowed to have intercourse with a
woman before he was 20 years old. It is to this abstinence
that Julius CGeser attributes the strength and large size of
these people.
Premature marriages have a pernicious influence upon the
public health. The young people ruin themselves by untimely
intercourse, which is moreover carried on to excess, in conse



SEXUAL EXCESSES.                  207
quence of the passions being uncontrolled by reason. The
children springing from such premature marriages, may be
fitly compared to hot-house plants, and lack inherent strength
and vigor.  It may be laid down as a tolerably certain rule,
that the male body is not fully developed before the 20th or
25th year.  Previous to this period, theismen ia ucot secreted
in sufficient quantity, is not sufficiently vivifying to generate
healthy life, and the children born of such imperfect parents,
are weak, sickly, and scarcely ever attain the fulness of
strength and growth.
If, in premature marriages, the man generally suffers more
than the woman, it is probably because the mother's weakness
is entailed on the foetus.
On the other hand, if premature marriages are extremely
hurtful and dangerous, an excessive delay in marrying may
likewise become injurious to health.  Marriages between persons of disproportionate ages are likewise attended with great
inconveniences.  The propagating faculty of one party may
still exist, whilst it had become extinct in the other. Sterility,
in such cases, is simply accidental.  Young women may not
bear children to enfeebled old husbands, whereas husbands of
corresponding ages and sexual powers, will very speedily
gratify the fervent desires of their hearts, to lavish a mother's
cares upon a tenderly-beloved infant. An inevitable consequence of marriages between persons of disproportionate
ages, is the physical weakness of the children. It has also
been observed that the skin of young women who marry old
men, becomes loose and withered, and breaks out in herpetic
eruptions.
As regards the second question: How often is it proper
to indulge without injury to health? it is equally difficult to
return a general answer; for this depends, likewise, upon a
variety of circumstances, race, age, temperament, and individual idiosyncrasies.  History tells extraordinary feats of some
men in this respect. Hercules is said to have impregnated fifty
girls in one night. The Emperor Proculus boasted of having
impregnated a hundred Sarmatian maidens in a fortnight.




208                SEXUAL EXCESSES.
Pharos relates of a Moorish prince, that he had intercourse
with forty women in three days. A woman requested protection of the king of Arragon against the passion of her
husband, who used her ten times every night. The king confined him, under penalty of death, to six times a day. A
mountaineer of the eastern slope of the Pyrenees, married
eleven women in the space of fifteen years. He used them
so often and vehemently, that all these women died of severe
uterine affections. He was forbidden to marry the twelfth
time. 
Such extreme cases are rare. As a general rule, men
would be ruined by such excesses. Physicians and physiologists of all ages, agree in opinion, that the loss of one ounce
of semen is more debilitating than the loss of forty ounces of
blood. Hippocrates tells us that the male semen is composed
of all the fluids of the body, and is the most precious constituent of the human organization. By losing semen, man
loses vital spirit.  It is not to be wondered, therefore, that
the excessive loss of semen enervates the body. It takes a
long time for the organism to repair the loss of:the seminal
fluid.  Twenty-four hours after a; seminal discharge, the
seminal vesicles are again full, but it takes a few additional
days, to impart to this semen vivifying properties of a healthy
nature.
Pythagoras terms the semen the flower of the blood; his
disciple, Alcmeon, considered the semen a portion of the
brain; Epicurus looked upon semen as a portion of the soul
and body, and exhorted his disciples to take good care of this
fluid'in order to preserve both their bodies and their souls.
All this shows that the most distinguished philosophers
have, at all times, looked upon the male semen as the most
precious secretion of the blood, and have cautioned against
the wasteful use of this fluid, as something ruinous to the
mind as well as the body.
As a general rule concerning the frequency of sexual intercourse, we may adopt the maxim of Luther, that " twice a
week, or one hundred and four times a year, hurts neither




SEXUAL EXCESSES.                  209
me nor thee." Celsus says: " Coit should neither be practiced to excess, nor should it be entirely avoided. If moderately enjoyed, it stimulates and invigorates the  body;
excessive intercourse, on the contrary, destroys the body.
Excess depends not upon the frequency, but upon the quality
of the act, upon the age and temperament of the parties.
Coit will not be hurtful, if it be not succeeded either by
lassitude or pain."
This rule is likewise applicable to women, although women
are less exhausted by intercourse than men, and preserve
their strength better.
Daily experience shows that a man will ruin himself by
excessive colt, whereas we see prostitutes getting fat in spite
of their dissolute life.  History, even, has preserved the
names of women who had carried their licentious habits to:
the highest degree without their health being visibly affected
by this libertinage.  Quartilla, a Roman woman, boasted
of iot remembering having'ever been a virgin, and of
requiring the use of a man at least thirty times a day.
Lysisca stood the embraces of fifty robust men in succession. Cleopatra entered in disguise the brothels of Rome, and
triumphed by twenty-five times over the bravest prostitutes.
In one night Messalina used one hundred and sixty men,
without being satiated.  Bertrand Rival relates that during
the first French revolution, a beautiful and modest girl
was ravished by twenty-eight hussars, and that the only
bad effects of this violence, were a slight irritation of the
vagina, and a few scratches, which soon healed again. On
another occasion, a prostitute accommodated thirty soldiers
without inconvenience.  Under Theodorus' reign, a woman
killed twenty-two men by sexual excesses. A physician of
Paris relates the case of a woman of forty years old, who
had used a man ten times a day for the last twenty-two years,
and who still enjoyed good health.
Women frequently complain that their husbands do not
satisfy them, but men are seldom heard to complain of their
wives.




210                 SEXUAL EXCESSES.
Such cases, however, are exceptions, and even these exceptions finally lead to important derangements. The constant
irritation of the sexual parts finally relaxes the rectum so
that it loses all contractile power; an incurable diarrhoea
sets in, and the dilapidated body perishes. Excessive coit
prevents conception, and leads to uterine diseases.
We will now devote a few paragraphs to the so-called
aphrodisiacs, and show how far they may be safely used, and
which of them have to be avoided. In spite of the warning
of physicians, numbers allow themselves to be entrapped by
such nostra, and to ruin themselves by the use of them.
Among the means which excite the sexual instinct without
injuring health, we distinguish in the first place the influence
of a pure and refined woman, and secondly, electro-magnetism.  He whose nerves are not stimulated by the neighborhood of a charming woman, or by the electro-magnetic current,
will likewise remain dull under the influence of spices, pills,
and potions, or these things will at most produce only a momentary effect, to the great prejudice of the organism.  To
these means may be added vivid descriptions of the sensual
delights of love, erotic songs, or pictures embodying lovescenes.  In the chapter on "impotence," we shall allude with
more minuteness to the use of electro-magnetism.  Some
vegetable preparations were likewise supposed to be endowed
with aphrodisiac properties. This applies more particularly
to the cryptogami, or the so-termed akotyledones of modern
botanists.  Gourmands know very well that truffles, mushrooms, ragoits, etc., are not eaten alone because they tickle
the palate.
Linnaeus relates that a variety of the orchideas (a species
of plants to which Dioscorides already attributed exciting
properties) stimulates the sexual instinct of the bulls of Dalecaria.  Fishes, oysters, crabs, eggs, celery, parsley, asparagus, mustard, vanilla, milk, figs, etc., are likewise supposed
to be endowed with aphrodisiac properties.
The inhabitants of the Orient excite their sexual passions
by opium, the use of which we would advise our readers, as




SEXUAL EXCESSES.                  211
little as the momentary suspension to which some Englishmen
are said to resort for the purpose of enjoying the pleasurable
excitement of the sexual organs which this suspension is supposed to procure.  It has happened that such voluptuous
sensualists were left to perish, the attendants forgetting to
cut them down.
Almost all nations, but particularly the Orientals, have
their peculiar aphrodisiaca, which shows that the sexual passions are highly esteemed everywhere. We repeat, however,
that all such artificial excitements of the sexual organ are
extremely injurious to the organism.  The bangi of the
Indians, and the maslac of the Turks, are said to be made of
a species of hemp. If the Indians wish to enjoy voluptuous
dreams, they take, previous to retiring, a potion composed of
bangi, areca-nuts, ambra and musk.  To excite the sexual
desire, the Chinese use a root which they term  ginseng, and
which is more valuable than silver. The wine of ginseng has
been introduced in Europe, but it does not seem to produce any
great results, and may perhaps be made of a root, which is not
the genuine ginseng.  For similar purposes the Chinese employ a mollusk, termed holothuria, or biches de mer in France,
which is found principally on the Charlotte islands and on
other islands of the South Sea.  This mollusk is dried and
smoked, and brings a high price in China.
Beside ambra and musk, the animal kingdom gives us other
excitants of the sexual organs, which are, however, dangerous
to health and even to life. One of the principal ingredients
of the so-called diablotins which are used in Italy and France,
is Cantharides, or the Spanish fly. These bonbons, the name
of which is significant of their abominable nature, were not
only used by enervated-rakes for the purpose of enjoying
once more the delights of the sexual passions, but they were
given to young girls who were intended as their victims, and
whose seduction was more easily accomplished after their
passions had been excited by such artificial means.
These diablotins were introduced at the courts of Henry
III. and Charles IX., by the notorious Catharine of Medicis.




212                 SEXUAL EXCESSES.
The bonbons which were used by Cardinal Richelieu in his
latter days, and which became fashionable at the court of
Louis XV., appear to have derived their principal effect from
cantharides.  The premature death of the celebrated poet
Lucretius, is attributed by his biographers, to a stimulant
which was given to him by his mistress Lucilia.  The celebrated physician Ambrosius Pare, relates the'case of a man
who died of hoemorrhage caused by a powder of cantharides
which was administered to him by his lady-love. A similar
death happened to an old priest who took a small dose of
cantharides to rouse the extinct sexual power. The deleterious effects of this drug may be inferred from the following
sad occurrence: A young rake took it into his head to excite
the sexual lust of two old male and female servants in the
family, and for this purpose he administered to them secretly
some tincture of cantharides.  That same evening both
servants were seized with such a wild desire that dangerous
hemorrhages ensued, of which the female servant suffered for
a long time after.
Narcotic poisons, such as opium and stramonium, are likev
wise very dangerous and equally deleterious in their effects
upon the organism.  Boerhaave relates the following case:An amorous old fool had won the affections of a young girl.
In order to excite her passion and enjoy her charms, he
administered to her, after a copious repast, a powder of
stramonium in a cup of coffee.  The girl became intoxicated,
her eyes sparkled with love, her face was flushed, she sang
amorous doggerel, lost all self-control, manifested an irresistible desire for sexual intercourse, took off her clothes, stared
at her old Adonis, finally trembled while desirous of giving
herself up to him, grated her teeth, and went into spasms.
The enamored old wretch went for a physician, who restored
her to health. After taking her coffee, she had lost all consciousness of what happened afterwards.
The so-termed philtra, elixirs of love, played an important
part among the ancients.  This name was given to certain
potions which were supposed to be endowed with the power




SEXUAL EXCESSES.                 213
of either exciting or'destroying love in an individual. But
even in modern times there are superstitious people who believe that a person's love may be won and retained by some
charmed potion. In Italy this faith is still prevalent among
a grea't many. The witty, but rather superstitious traveller,
William Muller, relates, in reference to this subject:
"The rendezvous of the Roman witches, of whom there
are a great many among the young and old women of the
city, is the ancient forum, now-a-days called campo-vecchio.
There they meet in the night, the largest and most solemn
meeting taking place in the night of St. John, when they
appear in the form of black cats with fiery eyes.  This transformation is effected by means of some mysterious ointment the
principal ingredient of which is said to be the root of pimpinella, and which is rubbed upon the whole body. Who is not
reminded by these witches of the Thessalian sorceresses?
These witches make brews which either excite love or hatred,
exorcise absent persons by means of magic formulas, and
raise storms. Philtra were originally made in Naples. During my short stay, I saw several emaciated young men who
were supposed by the people of the city, to have been brought
to this condition by elixirs of love. People are, therefore,
very careful not to give away their hair, because it is believed
that the spell of love is fond of adhering to the hair. It is
supposed that in Rome the people are nore safe. During
the carnival the bonbons which are thrown to one by masked
persons, are generally avoided; strangers are warned against
accepting.them.  Female masks frequently exclaim to the
passer by: "Eat the bonbon, do not be afraid, you are not
handsome enough to make yourself uneasy about any thing."
Although it is undeniable that these various influences tend,
by their narcotic or exciting virtues, to lull the victim to
sleep, or to excite the sexual passions, and facilitate the
nefarious scheme of the seducer: there are, on the other
hand, natural agents which exalt the sexual powers without
injuring the body. We know, for instance, that the sexual
instinct of cats is very much excited by valeriana, or by the




214                 SEXUAL EXCESSES.
nepeta pataria of Linnaeus.  Birds that are fed on foenu
Grsecum, buckwheat, and other kinds of seed, become very
much excited; even carps become heated by rubbing musk
on their posterior parts.
It is well known that the exhalations of animals are influenced by the sexual act, and it was therefore believed by the
ancients that such exhalations, being so intimately related to
the sexual functions, must likewise exercise a powerful influence on man; the mucus which is secreted from the vagina
of the mare during the act, and which was termed by them
hippomanes, was supposed to be an important agent. There
are other animal secretions which likewise stimulate the sexual
power, for instance: castoreum, ambra, zibeth, musk.  Ancient physicians used to mix all these things in their elixirs,
and even corresponding human secretions were added.
Diseases arising from an excessive development of the Sexual
Instinct, whether induced by artificial
or natural means.
I. SATYRIASIS.
This disease is peculiar to men only, and is much less frequent in our climate than nymphomania, which is peculiar to
females, and is characterized by similar symptoms.
The causes why this disease occurs less frequently among
men than among women, are various.  Man enjoys more
freedom than woman to gratify his sexual passion, he leads a
more active life, gets more tired by his labor, whereas woman,
especially in the higher walks of society, seems to live almost
exclusively for the purpose of indulging in sensations of every
kind.
Satyriasis is characterized by the following phenomena:
permanent erection, an excessive, insatiable desire for sexual
intercourse, which sometimes increases to a perfect frenzy.
The outbreak of the disease is generally preceded by frequent,
passing erections, which occur either spontaneously or at the
sight of women.' The imagination is continually tormented




SATYRIASIS.                    215
by lascivious images; sleep is disturbed by dreams, and by
frequent seminal emissions; the desire for sexual intercourse
is constantly increasing, and is gratified indiscriminately in
every shape and manner.  The patient is attacked with an
acute fever, the face looks fiery, the glistening eyes protrude
from their sockets, the mouth foams, the patient complains of
a burning thirst, becomes delirious, raves about the most
horribly lascivious things, and has to be prevented by force
from indulging in the most abominable self-gratifications. If
the patient is not speedily relieved by adequate treatment,
the sexual organs become inflamed, gangrenous, and death
terminates his horrible sufferings.
This disease may be caused by excessive sexual intercourse,
onanism, aphrodisiac medicines, especially cantharides, frequent reading of lascivious novels, irritations of the skin by
eruptions, flaggellations, excessive abstemiousness. In respect
to this last point, the history of pastor Blanchet, narrated by
himself, is very remarkable. Firmly struggling against the
sexual passions from his boyhood, he fled the other sex. But
being of a robust constitution, he was attacked with satyriasis at the age of 32 years, and was almost driven to frenzy.
His health was restored by the moderate enjoyment of the
sexual passion.
The treatment should not only be medicinal, but the mind
of the patient has likewise to be acted upon by adequate
treatment.  The imagination of the patient should be quieted
by cautiously and gradually presenting to it images of female
purity and loveliness, and the mind should be occupied by
mechanical exercises or easy intellectual labor; mechanical
labor has likewise to be resorted to.  Other means of cure
are: cold baths, douches, cold hip-baths several times a day,
moderate and cooling diet and drinks, sleeping on hard mattresses.
Among the remedies which are useful in this disease, and
which have to be chosen with reference to the bodily as well
as to the moral symptoms, we distinguish the following:
Agaricus, Agnus castus, Anacardium, Antihnonunm ecru



216                  SEXUAL EXCESSES.
dum, Arnica, Asafctida,,Asparagus, Aurum, Baryta car.
bon., Calcar. carbon., Camphora, Cannabis, Cantharides,
Causticum, Chin. mur., Crocus, Digitalis, ginseng, Graphites, Ignat., Kali carbon., Moschus, Nitric acid., Phosphorus, Stramonium.
(The principal remedies among this list are,
Asparagus, for sexual excitement, burning in the urethra,
the urine being covered with a white pellicle, and depositing
a fatty substance on the sides of the vessel.
Cantharides: Frantic sexual desire, with priapism  and
excessive pains.
Digitalis: Sexual excitement, with frequent and painful
erections at night and in the day-time.
Ginseng: Sexual desires, with, erections, lascivious dreams.
Mioschus: Violent sexual desire, also with nausea and
vomiting after an embrace.
These are the only agents that seem to have any positive
curative virtues in this disease, and they will doubtless cure
every case that admits of being cured.)
II. NYMPHOMANIA.
This disease arises from the same causes as satyriasis; such
as: onanism, sexual excesses, etc.; if neglected, it generally
terminates in craziness.  The disease is characterized by a
violent desire for sexual intercourse; such patients lose all
sense of shame, expose themselves to others, and utter the
vilest and most obscene speeches.
This disease occurs most frequently at the period of pubescence.  Women endowed with an exquisite nervous sensitiveness, or robust women, with a profuse crop of dark hair,
dark and lively eyes, expressive and animated features, and
well-developed sexual organs, such as: a hard and round
bosom, well-marked hips, tall stature, a large pudendum, a
prominent clitoris, are particularly predisposed for this disease. All these attributes may, however, be wanting, and
nymphomania may nevertheless break out.  In such cases




NYMPHOMANIA.                   217
the disease is generally caused by some eruption near the
sexual organs, worms, ascarides in the vagina, etc.
If nymphomania is fully developed, it presents a group of
most repulsive phenomena.  Such women assail every man
who comes near them, supplicate and excite him by the most
shameless requests to gratify their passions. Every new
gratification increases the desire.  If men are not at hand to
quiet them, they resort to the most horrible means of selfgratification, which it is impossible to describe without shuddering.
The treatment of this disease implies the regulation of the
diet and moral impressions of the patient. Exercise, employment, travelling, cold baths, cold douches, early rising from
bed, and absence of all confinement in a room, are indispensable means of cure. The reason of the patients has likewise to be appealed to.. Among the internal remedies, Platina
seems to have produced the best results. A successful treatment, however, requires that all the symptoms which do not
directly bear upon the sexual sphere, should be carefully
investigated. If the patients' eyes look glassy, their faces
are flushed, Belladonna and Conium are indicated. In other
cases we may employ Aconite, Arsen., Canthar., Jerrum,
Hyoscyam., Ignat., Phosphor., Pulsat., Sabina, Sepia, Silicea, Stramonium, Sulphur, and Veratrum album.
[Aconite is an admirable remedy for nymphomania characterized by a violent and distressing titillating sensation in
the clitoris.
Cantharis: burning in the pudendum, violent itching in
the vagina, pressing towards the genital organs.
Hyoscyamus: nymphomania accompanied with delirium,
loss of all shame, desire to expose one's self.
Ignatia: nymphomania, with deep melancholy.
Pulsatilla: nymphomania with suppression of the menses,
heat and weight in the pudendum.
Platina: excessive titillation in the uterus.]
15




218                 SEXUAL EXCESSES.
III. INVOLUNTARY SEMINAL EMISSIONS. SPERMATORRI(EA.
Spermatorrhoea is one of the most frequent, obstinate, and
disastrous consequences of sexual excesses, particularly of
long-continued onanism.  This weakness, which only exists
in the case of man, poisons every pleasure, and frequently
drives man to craziness and suicide.  The disease is quite
frequent now-a-days, but the phenomena which characterize
it, are generally attributed to some derangement of a cardinal portion of the nervous system, particularly the spinal
marrow, although such nervous derangements are generally
secondary, sympathetic affections.  Thanks to the microscope
and to a correct analysis of the urine, we find it easy to
diagnose the disease; and we aire likewise enabled, by the
progress of science, to cure it, provided the patient is willing
to obey the instructions of his physician.
Spermatorrhoea is the most frequent cause of impotence,
concerning which Hippocrates already remarks: "This disease frequently occurs among the recently-married, and in
consequence of sexual excesses; there is no fever, the appetite remains good, but the strength vanishes, and the patients
grow thin. They complain of formication from the head down
the spine; semen is lost with the urine, and at stool, also
during sleep, with or without dreams, or while riding on
horseback, or during a walk. The patients become impotent,
debilitated, the head feels heavy, and they experience a buzzing in the head. " If fever supervenes, the patients die of
consumption, etc.
The semen may escape in a threefold manner:
I. During stool, at the termination of an emission of urine,
during sudden motions, conversation with females, or while
reading lascivious novels or songs.
2. At night, while dreaming, with or without any particular sensations, frequently only towards morning, when the
bladder and rectum are full; in the more advanced stages of
the disease the semen escapes while lying on the back, or
sleeping on the sofa. Generally the patients wake during the




SPERMATORRH(EA.                    219
emission, at other times the loss is perceived only by the
stains on the linen.
3. The semen is mixed up with the urine; there is no
erection, nor any peculiar sensation of pleasure.  This is
spermatorrhcea in the genuine sense of the term. This is the
most dangerous form  of spermatorrhoea, because it is not
perceived until it has developed its disastrous consequences in
the organism.  In some cases several of these various forms
of spermatorrhoea co-exist in the same individual; but as a
general rule, only one form exists at a time; some lose the
semen with the urine without having ever been troubled with
emissions; others lose semen during an exertion, but never
with the urine; generally, however, the influence upon the
organism is the same in these various cases.
Besides the above-mentioned causes of this disease, sexual
excesses of various kinds, there are still other causes which it
is important to investigate in order to regulate the treatment
accordingly.
Sometimes the disease arises from the joint action of several causes, in which case it is difficult to ascertain the leading
one. Pathologically, the phenomena of this disease, may be
divided into two chief categories: an irritation of the lower
portion of the spinal marrow, and secondly, an irritation and
chronic inflammation of the ejaculatory canals, and seminal
vesicles. As regards the special causes, the following may
be looked upon as the principal ones which are instrumental
in producing this disease:
1. Gonorrhoea, especially chronic gonorrhoea.  This is
generally located in the posterior portion of the urethra,
where the seminal ducts terminate.  Hence the necessity of
removing, as soon as possible, even the lighter forms of this
disease.
2. Irritatinginjections in the urethra.  These injections,
if used to excess, or at improper periods, or if too acrid, frequently cause the inflammation of the mucous membrane to
extend to the posterior portion of the urethra.
3. Strictures of the urethra.  Behind the stricture the




220                 SEXUAL EXCESSES.
urethra generally enlarges, the mucous membrane is irritated
by the urine which collects in the enlarged portion, an increased quantity of mucus is secreted, and the inflammation
generally spreads to the more deep-seated portions of the
urethra.  While endeavoring to expel the urine, the orifices
of the seminal ducts become relaxed, and the involuntary
discharge of semen is facilitated thereby.
4. Morbid conditions of the rectum, such as obstinate constipation, piles, painful fistulae of the anus, tumors, diarrhoea.
Some of these conditions act mechanically in consequence of
the effort which is required during stool; others, like the
piles, by communicating the irritation to the seminal vesicles.
5. Onanism. This is undoubtedly the most frequent cause
of spermatorrhoea.  This disastrous habit induces a constant
irritation of the sexual organs, a more frequent and more
copious determination of blood to these parts, which is alone
sufficient to cause a loss of semen. After such an irritation
has lasted for a time, the internal sexual parts become
weaker, relaxed, particularly the orifices of the seminal' ducts,
in consequence of which the seminal fluid escapes more easily.
6. Sexual excesses with women.-These injurious consequences are of a three-fold kind: First, an increased secretion
of semen in consequence of the frequent irritation of the
sexual parts; secondly, relaxation of the whole body, and
particularly of the sexual organs; thirdly, irritation and even
chronic inflammation of the seminal vesicles and the ejaculatory ducts, which may be inferred from the suddenness with
which the semen is discharged, and from the pain by which
the discharge is accompanied.  The bad effect is still increased by retaining the semen as long as possible, either for
the purpose of perpetuating the pleasurable excitement, or
from  some other cause.  By this means the vesicles and the
ducts become distended, and the orifices of the ducts lose
their tone and elasticity.
7. Frequent excitation of the sexual instinct, without subsequent natural gratification, either by lascivious books, or
by intimacies with females, except sexual intercourse. In




SPERMATORRHIEA.                   221
consequence of this excitement, there is a considerable rush
of blood to the sexual parts, the penis swells, becomes erect,
and such erections last much longer than during an embrace;
a viscous transparent fluid, the prostatic fluid, or even real
semen, is discharged from the urethra; a violent throbbing
sensation is experienced in the perinaeal region, the face
becomes flushed, the heart beats more violently, and a frequent repetition of such fruitless intimacies, brings on formication and shooting stitches in the back.  The immediate
consequence of this exaltation is a relaxation of the seminal
vesicles, and of the orifices of the seminal ducts, which are
endowed with a similar but weaker power as the sphincter
muscles of other orifices of excretory ducts.
8. Abstemiousness.  Excessive abstemiousness may likewise be attended with involuntary seminal losses. With many
persons, abstemiousness is no virtue, because they are not
tempted by enjoyment, and there is no virtue without temptation.,There are men who practice abstemiousness from
religious motives, at the expense of their health. In a fullgrown young man, especially if he lives well, the testicles
constantly secrete semen which ought to be discharged from
time to time, proportionally to its quantity and the rapidity
with which it is secreted. If this discharge is not effected
by colt, the excess is got rid of by involuntary nocturnal
emissions, the frequency of which is proportionate to the
quantity,of semen secreted. As long as these nocturnal
emissions take place moderately, they afford a feeling of ease
rather than otherwise. But it frequently happens that these
emissions.take place every night, especially if the patient
had been given to excessive intercourse previous to becoming
abstemious.
9. Diseases of the cerebellum and the spinal marrow. We
know by physiological experimentation that the cerebellum
and the medulla oblongata are in close relation to the sexual
organs.  It has been noticed that a disorganization of the
cerebellum impairs the sexual functions, and that a complete
atrophy of the cerebellum  is succeeded by their complete




222                  SEXUAL EXCESSES.
extinction.  Gall already directed attention to the fact that
the cerebellum is the seat of the sexual power. In his craniology we find a number of cases going to show that certain
diseases of the brain, such as: inflammation, tumors, mechanical injuries inflicted by a blow, concussion, etc., cause a violent
excitement of the sexual passion, and consequent seminal
emissions.
Various diseases of the spinal marrow are still more frequent causes of spermatorrhoea, because a flow of semen is a
standing symptom of many such spinal irritations, and consequently increases the debility. In these diseases the sexual
organs are deprived of the normal nervous influence which
they require for the healthy exercise of their functions.
Sometimes the semen is secreted in too large a quantity, but
too thin and not sufficiently vivifying. The seminal vesicles
are overfilled; the excretory ducts become relaxed, as is the
case with the sphincter vesicle under similar circumstances;
the testicles hang down relaxed; shooting stitches are experienced in the spermatic cord; the erections are either imperfect
or entirely wanting, and an unavoidable consequence of this
condition is impotence, tabes dorsalis, etc., of which mention
will be made hereafter.
10. Excessive length of the prepuce, and consequent phymosis, may likewise lead to involuntary emissions, caused by
inflammation of the surface of the glans, sensitiveness of the
glans, copious accumulation of smegma behind the corona
glandis.  This sensation spreads from the glans to the inner
parts, and causes involuntary emissions. Such emissions are,
however, easily arrested.
11. In a number of cases an involuntary loss of semen is
hereditary.  We know this from actual observation.
12. Excessive use of tea and coffee likewise causes seminal
losses. It is true that both tea and coffee act powerfully upon
the kidneys, but their injurious effect upon the sexual organs
is not yet proven, although a number of persons who were
afflicted with seminal losses, have said that their trouble
became much worse after the use of coffee or tea.




SPERMATORRHCEA.                   223
13. Aphrodisiaca, cantharides, violent cathartics, warm
and irritating injections, cause an increased flow of blood to
the pelvic organs and sexual parts, and consequently an irritation of the seminal vesicles leading to seminal losses. The
injurious effects of such agents have been described before,
and our readers are referred to those pages.
14. In a former paragraph we alluded to intestinal worms,
and stated that they were capable of irritating the sexual
organs.  It is especially ascarides which are capable of exciting spermatorrhoea, by causing a violent irritation of the
internal sexual organs, in consequence of their irritating
action upon the nervous system generally. This circumstance
deserves particular notice from the fact that the presence of
such worms is easily overlooked; whereas, if the cause were
properly noticed, its removal could easily be effected.
15. Besides the above-mentioned causes, there are others
which may give rise to spermatorrhcea, such as riding on
horseback, in consequence of the continued pressure and
shaking of the genital organs; a sedentary mode of life
which is apt to induce constipation and an increased warmth
of the abdominal organs by congestions of the portal system,
and lastly various idiosyncrasies which it is not always possible to account for upon physiological principles. There are
cases where patients had not felt well for a time and afterwards were suddenly attacked with copious nocturnal emissions, without any of the causes which we have enumerated,
being present.  I have known a case where a man who had
entered a house of dubious character, was suddenly seized
with a copious loss of semen without erection, and without
the least thrill, merely from  fright.  Many persons are
attacked with seminal losses on looking down from a height,
or while fancying they are lying on the border of a precipice,
or while balancing themselves on a swing.
As regards the phenomena which generally accompany
spermatorrhoea, we have to consider in the first place whether
the seminal losses take place in the day-time or at night.
Nocturnal emissions are at first accompanied by lascivious




224                  SEXUAL EXCESSES.
dreams, erections and pleasurable sensations. As the trouble
increases these sensations grow less, and the loss of semen is
only revealed by the moisture or the stains on the linen.  At
first the emissions occur less frequently, afterwards two or
three times a week, then every night, and even several times
in the night. Gradually the semen loses its consistence, the
color and smell become altered, the spermatozoa diminish in
number, the semen is changed to a thin, transparent mucus,
and is sometimes mixed with blood.  When the disease has
reached this stage, a soft or fresh bed, a full bladder or
rectum, a little warm  beverage, rubbing the penis against
the shirt, and such like trivial causes are sufficient to cause a
loss of semen.
In other cases the losses are excited by rather unusual
causes, such as fancies concerning the copulation of certain
animals, flies, snails, etc. Afterwards sleep is disturbed by
frightful dreams, the patients are attacked with nightmare,
and finally the emissions take place without any pleasurable
sensation; on the contrary, they are painful.  It is such
emissions as these that are peculiarly debilitating.
In the day time the loss of semen generally occurs during
an emission of urine or at stool-there is no erection and
no thrill. At stool the semen passes off while pressure is
made upon the rectum; in such cases the bowels are generally constipated, and the cause of the loss is more or less of
a mechanical nature. Drops are discharged from the urethra
of a grayish-white color and a peculiar odor, which, under the
microscope, are found to contain spermatozoa. If the seminal
fluid becomes altered, clear, colorless, thin, without any peculiar smell, the patient is generally without any suspicion. In
such a case the spermatozoa have disappeared from the fluid.
If the semen passes off during an emission of urine, the loss
occurs not while the urine is flowing out, but when the last
drop is about to be discharged; sometimes only now and then,
not with every emission of urine. In most cases the seminal
loss occurs in the morning, when the urine is discharged for
the first time after rising; the last drops of urine are gene



SPERMATRROI(EA.                   25
rally thicker, viscous, ropy, adhere to the orifice of the
urethra, and stain the linen like starch.  If the urine is
collected in a goblet, it becomes somewhat turbid, and at
the bottom of the vessel we perceive small, rounded, transparent little granular bodies of various shapes.
If the seminal loss is accompanied by spinal irritation, the
urine deposits in the morning and forenoon a copious, lightbrown sediment; it reacts like an acid, has a sickly odor,
is never entirely clear, and shows at the surface a fine,
opalescent greasy pellicle, which, after removal, is invariably
reproduced.
In other cases a regular seminal emission is caused by the
sight of a girl, by dancing with her, by some lascivious fancy
or scene, or by looking at some lascivious picture, by riding
on horseback or in a carriage, by hard walking, etc. In such
cases the erections and pleasurable sensations continue for a
time, but disappear entirely after the disease had lasted for
awhile.
One of the unavoidable consequences of this weakness is
impotence. The quality and consistence of the semen become
altered, the spermatozoa either disappear or die, or are so
weak that they lose all fecundating power.  Coit can only
be carried on imperfectly, in consequence of the semen being
expelled too soon. Gradually the erections cease altogether,
owing to the increasing weakness of the penis.
The disastrous consequences of excessive seminal losses
will not astonish any one who considers that the semen is the
most precious and most concentrated secretion of the human
organism.  The production of semen takes place much more
slowly than that of any other secretion in the human body.
This is owing to the length of the route which the semen has
to traverse, for all the seminal canals of the testicles unite
into a net-work, from which the fifteen or twenty coni vasculosi IHalleri pass into the larger extremity of the epididymis;
if all these seminal canals were extended in one line, it would
be about 1,050, and, according to the English anatomist,
Monro, even 5,208 feet long.  This immense length shows




226                 SEXUAL EXCESSES.
that it is not only difficult for the semen to be reproduced,
but that its excessive use must be attended with disastrous
consequences to the general organism. All the functions are
affected, and the destruction of the body may even be caused
by such abuses.  No other functions in the body affect its
normal condition as much as do the sexual functions. However, it is impossible to lay down rules in this respect which
admit of no exceptions. Even the structure, constitution and
mode oflife of certain persons do not seem to influence the
sexual powers in the least. Apparently weakly individuals
will sometimes bear considerable seminal losses without any
detriment to their general health, whereas, on the other hand,
robust individuals are affected by a trifling expenditure of
their seminal fluid.
The effects upon the spinal marrow, which is deeply involved
in the sexual act, and still more in the practice of self-abuse,
are likewise very different in different individuals.  As soon
as the irritation of the spinal marrow passes certain bounds,
it becomes permanent and has a prejudicial influence upon
the sexual sphere as well as upon the whole body. Volition
especially, is impaired by the extreme excitability of the
nervous system; the activity of the voluntary muscles is likewise affected to such an extent that all their energy may be
lost and complete paralysis set in. What impairs the moral
and mental condition still more than the loss of the seminal
fluid, is a certain revelling in lascivious fancies, which is the
more dangerous the more secretly it is indulged in, and the
younger and feebler the persons who are addicted to such
excesses.  The higher functions of the soul are almost
entirely destroyed by them, and all the purer and nobler
thoughts are constantly superseded by the imagery of a
libidinous imagination; this unnatural indulgence affects the
sensorium, the spinal marrow, digestion and nutrition. By
the time the patient is made aware of his error, all these
phenomena have acquired a more intense development. The
effect of these silent transgressions is the more formidable the
younger the culprit, and the weaker his constitution and the




SPERMATORRHOEA.                  227
desire to discontinue his evil practices. No abuse is fraught
with more destructive consequences than onanism.
We will now proceed to point out the consequences of
excessive seminal losses, and more particularly their debilitating influence on the various organs of the body, and above
all upon the nervous system.
In the beginning of this work we made allusion to a statement emanating from Hippocrates, that such patients eat
with an excellent appetite, and' nevertheless grow thin.
Indeed they do have a great craving for food, and use it in
large quantity, fancying that this will repair their strength;
unfortunately the constant loss of semen gradually diminishes
and finally destroys the power of digesting the food. The
patients complain of weight in the stomach, distress, restlessness; the pulse becomes irregular, and cerebral congestions
set in, the patients incline to perspire during the process of
digestion, they become drowsy, unable to think or work; they
experience sour and fetid eructations, the stomach is distended
with gas, a rumbling, and colicky pains are experienced in the
bowels, the stool becomes irregular, costiveness alternates with
diarrhoea; at last the constipation becomes permanent and
keeps up the seminal loss. These derangements continue to
grow worse; occasionally the patients feel a little better, but
they do not seem to appreciate the real cause of their trouble,
or else they are too bashful to discover it to a physician. The
patients lose flesh, grow sensitive to the cold, have a yellowish
complexion, with blue circles around the eyes.  The tone of
of all the organs of the body is depressed; the voice becomes
thinner, almost like that of a woman; the patient is taciturn,
and the consciousness of being the author of his misery,
renders his speech timid and impairs his whole activity. As
the emaciation increases, the skin becomes pale-yellow, the
eyes retreat into their sockets, the eyes grow dull, the muscular energies sink, the patients grow weary from the least
exertion. At times a weakness of the lower limbs, bordering
upon paralysis sets in. In many cases the calves lose their
substance first, in consequence of which the gait becomes
heavy, dragging, without energy.




228                 SEXUAL EXCOESSES.
Not all such patients grow thin, many of them retain their
go:d appearance, red cheeks and all the signs of health, but
they feel weak, and are tormented by many distresses which
drive them to suicide.
An almost constant symptom with which such patients are
affected is a constant desire for motion, notwithstanding that
they feel exhausted and distressed after every exercise. The
patients experience a vehement desire to change their places
all the time.
In common cases the disease runs its course without any
fever, unless it should be complicated with inflammatory diseases. The patients are seized with irregular chills along the
spinal column, in the arms and legs; soon after they experience a sensation of warmth and throbbing in the perinpeum,
flushes of heat from the chest to the head and on the sides
of the neck, morbid contractions of the laryngeal region
with sudden stoppage of breath as if a foreign body had
lodged in this region. The large vessels of the neck throb,
and, on auscultating this region, we perceive the so-termed
bruit de diable, as exists in chlorotic girls. Sometimes the
patients are attacked with palpitation of the heart on taking
the least exercise; the night's rest is disturbed by a tumultuous beating of the heart which either sets in spontaneously
or is preceded by heavy and disturbing dreams.  The palpitation of the heart is increased by both agreeable and disagreeable emotions.  The patients are apt to lose their breath
when  walking, running, and particularly when going up
stairs; a sense of emptiness, heaviness in the head and buzzing in the ears are experienced. The patients are frequently
obliged to take breath and are liable to taking cold; pains
and shooting stitches in various parts of the chest and back,
especially in the region of the heart, often frighten the patient,
and a dry cough soon develops itself. Pulmonary phthisis is
very frequently the result of such disturbances.
The constant loss of animal fluids and the disturbed digestion lead to a deterioration of the blood. The blood becomes
watery, loses part of its fibrine and albumen, the blood



SPERMATORRH(EA.                    229
disks diminish in number, the white globules increase to
excess, and the blood is less coagulable.
Beside these derangements of the digestive organs, of the
muscles, blood, lungs and heart, the nervous system is particularly affected.  The cerebro-spinal axis, as well as the
peripheral nerves and the organs of the senses, are involved
in the disastrous effects of spermatorrhoea.
The visual power is particularly weakened.  The pupil
dilates, short-sightedness and diplopia set in, black or shining
points hover before the eyes, even blindness may set in, the
eyes are extremely sensitive to the light.  If the spermatorrhoea was caused by onanism, the look becomes unsteady,
erratic.  The hearing loses its power of accurately distinguishing sounds; very often the patients lose their hearing
entirely, and nevertheless they are troubled with a distressing sensitiveness to unpleasant sounds, were they ever so
trifling. Various unpleasant noises are perceived in the ears.
The taste is likewise altered; the tongue is constantly coated
with a thick phlegm, rendering the mouth sticky and pappy.
In the extremities a feeling of coldness is experienced;
sometimes a perfect loss of sensation takes place over a more
or less extensive region.  Sometimes the loss of sensation
shifts from  one place to another.  A  passing sensation of
burning and heat, or a sensation as if cold air were blowing
upon certain parts of the body, or as if water were dropping
upon it, or as if an electric aura or stroke were passing
through it, are experienced. The extremities are disposed to
go to sleep, or a formication is felt in the extremities, along the
back, in the lumbar region, on the thighs; the limbs suddenly
start especially during sleep and shortly after falling asleep,
sometimes even in the day-time while the patients are absorbed in thought.
Patients affected with spermatorrhoea, generally become
languid, effeminate, pusillanimous; the power of volition is
very much weakened; volition is readily excited, but it does
not last, there is a lack of firmness; the patient has the best
intentions, but is unable to carry them  out; in the more




230                 SEXUAL EXCESSES.
advanced states of the disease the power of volition is
entirely destroyed. The patients become diffident, sensitive,
capricious, irascible; the least untoward event excites their
anger, but grave insults do not seem to disturb them, they
are afraid of resenting them. Towards the female sex such
patients are cold, they avoid the society of females and
scarcely dare look them in the face; they prefer solitude, are
sad, low-spirited, melancholy; they like to indulge in glowing thoughts.  They are averse to any kind of work, they
loathe life and often think of killing themselves, nevertheless
they are constantly tormented by a desire of recovering their
health.  They are constantly thinking of their condition;
they observe the urine, stool, watch their digestion, and all
the other functions.  They show an indifference to every
thing, neglect their business, and are everlastingly tormented
by the thought of having lost their virile powers. Depression of spirits and hope, joy and sadness alternate in quick
succession according as the involuntary losses of semen occur
more or less rapidly, or according as the patients are impressed with the idea of either being better or worse. If this
fitfulness of spirits should be ascribed by the patients or
those around them to any other cause but the true one, itself
becomes either a source of joy or grief to them, especially
on comparing the present with the past.  The memory is
frequently impaired, and, in persons endowed with higher
intellectual powers, the flight of ideas is considerably embarrassed; the imagination loses its vivacity, and the acuteness
and discriminating power of the reasoning faculty are weakened.
These symptoms, although they excite legitimate suspicions
of the existence of the disease, are however not sufficient to
remove all doubt in reference to it. To obtain perfect certainty the physician has to convince himself that there is an
actual loss of semen and that the quality of the semen is
altered.  The stains on the linen are positive proofs of the
seminal loss in the day-time and at night. If, in consequence
of the long continuance of the disease, or of the debilitated




SPERMATORRHCEA.                   231
state of the patient's constitution, the semen should have
become too thin and watery, the recognition of the disease
by the stains on the linen would be more difficult.  The
difficulty of the diagnosis is greatest when the semen is discharged with the urine. This circumstance is so much the
more dangerous as the weakness may continue in this way
for a long time without being perceived, and as this unperceived loss implies a more deep-seated relaxation of the seminal vesicles and their excretory ducts.  In such doubtful
cases the urine should be examined with great care, particularly the last drops of the urine which will be found distinguished bythe following characteristic phenomena: At the
bottom of a transparent vesicle we perceive small little globular
bodies or flocks, of a somewhat shining exterior; after filtering
the liquid, these flocks and the spermatazoa remain behind
on the filter.  Viewed with the unarmed eye, the globules
appear of different sizes and numbers; they do not dissolve
even in boiling water. Alcohol, nitric acid and a solution of
tannin cause them to coagulate like albumen.  Inasmuch as
these phenomena likewise take place when the prostatic fluid,
which sometimes is discharged together with the semen,
escapes alone, the use of the microscope is absolutely necessary to establish a correct diagnosis.  If the alteration of
the semen is considerably advanced, these flocks disappear,
but the spermatazoa which are heavier than the urine, fall to
the bottom of the vessel.
A valuable diagnostic is the constant formation of a number of crystals of the oxalate of lime in the urine.
An examination of the semen by means of the microscope
enlightens us concerning the quality and numeral increase or
decrease of the spermatozoa. If the seminal loss had lasted
a long time, the spermatozoa diminish in number, are imperfectly developed, move about slowly or are quite motionless.
Afterwards they shrink to one-half or one-third of their
normal size.  If marasmus sets in, the spermatozoa disappear
entirely, and in their stead we behold shining, roundish little
bodies, which are probably the heads of the extinct sperma



232                 SEXUAL EXCESSES.
tazoa.  This kind of semen is devoid of all fecundating
power. If an improvement in the condition of the patient
takes place, the spermatozoa reappear in the semen, and their
reappearance encourages the hope of the ultimate restoration
of health and of the virile powers.
As regards the treatment of this most important disease,
there is no doubt that it demands the most rigid attention,
both on the part of the physician and patient. For, although
the ravages which this disease causes in the human system,
are deep-seated and obstinate, yet, if the treatment is conducted by a physician of good sense and endowed with
consciencious patience, it may terminate in most cases in
recovery. I have treated a number of patients who had
despaired of themselves, but who not only recovered their
spirits but their health and became happy fathers of a family.
Unfortunately, such patients are too often inclined to confide
themselves into the hands of quacks, instead of applying to
some honorable physician, who not only knows how to use
physical but likewise suitable moral means of cure.  Considering the high importance of this disease, I deem  it
proper to go into the treatment-of this disease as extensively
as space will permit, without omitting any complications or
coincident affections.
The first duty of the physician consists in obtaining from
the patient a confession of his errors, and a firm promise
that he will abandon his evil practices. Until this is done no
treatment can be of any avail.  The patient must be given
to understand, and to this end the physician should exert all
his eloquence and persuasive powers, that no cure is possible
unless the patient obeys the advice of his medical friends with
the utmost conscienciousness. Let the patient understand
that a cure is possible, provided the patients subject themselves to a rigorously systematic treatment.
In the first place it is of the utmost importance that the
pernicious practice of self-abuse should be abandoned. Next
the diet has to be regulated in the manner which will be
described hereafter.




SPERMATORiHmEA.                    233
If the patient is troubled with nocturnal emissions, all
spices and stimulants have to be carefully avoided, especially
in the evening; all kinds of spirits, wine, brandy, tea, coffee,
have likewise to be given up; in general the patient should
drink very little in the evening, in order to keep the bladder
tolerably empty. Before retiring.to bed, the bladder and rectum  should be emptied of their contents, if possible; it is
likewise well to void the urine soon after rising. Inasmuch
as the emissions generally take place towards morning, it is
well to rise early, towards five o'clock; as a general rule it
is injurious for such patients to sleep later in the morning, for
the lascivious dreams generally occur towards day-break, if
the patients fall asleep again after waking. The bed upon
which the patient sleeps should not be too soft; horse-hair or
straw mattresses, or the recently-invented hard elastic bed,
are far preferable to feather-beds.  The patient should not
sleep on his back, but on the side. Previous to retiring the
fancy should not be excited by lascivious conversation or
books. All intimacy with the other sex in the evening-hours
should be avoided; in general any intercourse with females,
which results in sexual excitement, without gratification, is
hurtful at any time. Body and mind should be occupied in
an useful manner. Exercise in the open air is-advantageous
even in the higher forms of the disease. The nature of the
diet, whether it ought to be light or nutritious, is to be determined by the attending physician, and depends in a
measure upon the character of the disease. If this should be
chronic inflammatory, the diet should consist of light food,
such as easily digested vegetables, light farinaceous preparations, little meat, fruit, etc.; wine and beer, tea, coffee, should
be avoided; water, a light lemonade, and effervescent beverages may be used. If the patients should be very much reduced by the disease, nutritious food may be resorted to, and
even a little wine or beer may be used, but discreetly.
Bathing in a river, and cold baths generally, shower-baths
and wave-baths, douche, cold hip-baths, injections of cold
water, are much to be commended.  The cure is likewise
16




234                 SEXUAL EXCESSES.
promoted by gymnastic exercises, and by residing in the
country where the scenery is beautiful and the air healthy
and invigorating.
The private habits of the patient should never be lost
sight of, and the ruinous consequences of self-abuse should be
continually kept fresh in his soul's memory. In the case of
children, judicious punishments may be resorted to, to deter
them from such habits.
This dietetic and moral treatment, which we deem of great
importance, we accompany with the internal use of Carbo
veget., Causticum, China, Graphit., Petroleum, and Phosphorus.
[To these remedies may be added three agents, which I
have found of great efficiency in the treatment of gastric,
nervous and numerous disorders arising from  the habit of
self-indulgence; these agents are: Aconite, Mercury, and
Nux vomica.
Aconite is indicated by great nervous derangements, sudden
starting at the least noise, fitful mood, depression of spirits,
apprehensions for the. future, dizziness, intense frontal headache, either every forenoon or constantly, dryness of the
mouth, coated tongue, distress in the pit of the stomach,
vomiting of the ingesta, wakefulness at night, drowsiness in
the day-time, nightmare, copious and exhausting emissions
every night, costiveness. This agent will be found of no use
in this disease, unless it is administered in the form of tincture, one or two drops of the concentrated tincture in a
tumbler full of water, a teaspoonfull every three or four
hours, until a decided improvement sets in.,Nux vomica may be given, one dose of the 6th att. every
other night) if the patient complains of costiveness, bad taste
in the mouth, soreness of the stomach, distress after eating,
fulness in the pit of the stomach, constipation.
Mlercurius vivus is adapted to the following symptoms:
pappy mouth, thinly coated tongue, altered taste, sallow complexion, chilliness, great sensitiveness to the air, costiveness,
the alvine evacuations being composed of hard balls or lumps,




SPERMATORRII(EA.                  235
having a dark color. Give a powder of the third trituration
every night.
Carbo veget. will be found adapted to constipation with
heartburn, acidity of the stomach, distress after eating, distension of the bowels. If this agent should not relieve the
patient,
Phosphorus may be substituted, especially if the nervous
system  seems to be very much shattered, and the patient
complains of oppression on the chest, tendency to cough, pains
in the chest. This medicine may be used alternately with
China, if the patient is very weak, the least exercise tires
him' and he is troubled with a ravenous craving for food.]
One of the most efficient remedies in this disease is electromagnetism; indeed, I look upon it as indispensable in the
treatment of this affection.  I commence the treatment by
first inducing, with my hand, an electro-magnetic current
along the back of the patient; after a time I substitute the
cylinder in the place of the hand and lastly resort to the
electro-magnetic baths. The passes have to be made along
the whole length of the spinal column.  Sometimes I apply
one pole to the perinseum, and the other one to the lumbar
region.  The current has to be induced very methodically.
The first applications should not last longer than five minutes;
afterwards every application should be increased by one or
two minutes, until we gradually prolong it to about fifteen
minutes, after which every succeeding application is shortened
again by one minute.  Already after the first days of the
treatment the patient will perceive an amelioration: his
apathy and his indifference to the enjoyments of life will be
succeeded by a feeling of ease and physical well-being; the
seminal losses will either diminish or cease entirely, and all
the other morbid phenomena will gradually disappear, and the
appearance of the patient will mend considerably. But even
if the improvement should be ever so striking, the treatment
should not be discontinued all at once, for their affection is
disposed to return; it is therefore advisable to continue the
treatment some two or three weeks even after the patient




236                 SEXUAL EXCESSES.
should seem perfectly restored; the diet should likewise be
continued, although, if desired, in a modified form. It need
scarcely be remarked that sexual intercourse should be enjoyed with moderation, and the vicious practice of self-abuse
should never be resumed.
IV. IMPOTENCE AND STERILITY OF THE MALE.
These two weaknesses, although differing in form, resemble
each other in one respect: both arrest the faculty of propagating the species.
By impotence we mean an inability to exercise the act of
coit.  Impotence is necessarily accompanied by sterility.
In sterility coit may actually take place, but there is no conception. Generally speaking impotence applies to the male,
and sterility to the female.
Impotence may either be congenital or acquired; it may
continue only for a period, or during a man's life-time.
The causes of impotence and sterility of the male may be
general, local and relative. The general causes refer to the
constitution, the composition of the blood and the state of
the nervous functions.  The ancient physicians were only
acquainted with constitutional causes, hence their theories
concerning the character of these weaknesses were incomplete and erroneous.  In modern times we have discovered
an increasing number of particular conditions which bear
upon the development of these weaknesses, and we have
succeeded in establishing a line of demarcation between the
constitutional and local causes. These investigations have
led to considerable improvements in the treatment of these
weaknesses, to such an extent that we are now able to cure
a great many cases which had to remain uncured heretofore.
Among the constitutional causes we number diseases that
weaken the body with more or less rapidity, and which result
in an alteration or actual toxication of the blood. Onanism
is one of the most frequent causes of impotence. The action
of the syphilitic virus might likewise lead to impotence in
the male; in the most favorable cases this poison, if it does




IMPOTENCE OF THE MALE.                237
not'produce perfect sterility, yet destroys the life of the
fetus.
The inability of procuring an erection is one of the most
frequent causes of impotence.  This inability is frequently
the consequence of onanism or of sexual excesses, especially
if they had been indulged in prematurely, or it may amount
to a sort of paralysis of these parts caused by irritation of
the lower portion of the spine.
Generally, excessive passion during the sexual act, and the
violent orgasm of the parts caused by this fierce vehemence,
are the main causes of sterility in the male; on the other
hand, a certain timidity in performing the act, or a certain
fear that it might not be adequately performed, may lead to
temporary impotence.
If the desire for an embrace is entirely wanting, all intercourse between the sexes becomes impossible. This perfect
suppression of all desire sometimes exists in persons addicted
to intense mental labor, or leading a secluded and exceedingly abstemious life. Long abstinence from sexual intercourse has the same effect upon the sexual passion.
Impotence is also chiefly caused by diseases of the brain
and spinal marrow arising from onanism and sexual excesses,
and to which we shall refer more in particular hereafter.
Diseases of the urinary and sexual organs, and abdominal
affections likewise weaken the sexual functions. Intoxication
is an obstacle to sexual intercourse. It has been observed in
Holland that drunkards are frequently affected with impotence, and among the nations of the north of Europe the
abuse of spirits has likewise led to an increase of this weakness.
The sexual power is likewise affected by the age of a
person. Old men generally become impotent.  Some, however, preserve their virility to the age of seventy, and
upwards, especially if they had been virtuous and sober men
in their youth.  Cato had a son at the age of eighty; Massinissa, King of the Numidians, and Abraham  procreated
children at the age of ninety. Self-abuse and premature




238                  SEXUAL EXCESSES.
excesses lead to a premature cessation of the virile powers,
the semen loses its vitality, and the sexual act remains incomplete. It is supposed that the excessive use of strong black
coffee and tea likewise cause debility of the sexual organs.
The local causes of impotence may be various, either
purely physiological and functional, resulting in alterations
of the secretions, or organic and congenital.  Malformations
of the sexual organs cannot be cured, and we mention them
simply for the sake of completeness, and in order to caution
patients against making any useless attempts at cure.
A morbid alteration of the seminal fluid is one of the chief
physiological causes of sterility.  The semen constitutes the
most important fecundating agent on the part of the male,
and its fecundizing virtues depend upon the presence of a
large number of fully developed spermatozoa.  If these
spermatozoa are diseased, or entirely wanting, the semen
loses all power of fecundating the ovum. Alterations of the
semen may occur in consequence of severe, debilitating diseases, of imperfect restoration of the tissues either from
deficient nutrition or imperfect digestion; or in consequence
of excesses of various kinds, continued losses of animal fluids
and more particularly of the seminal fluid.  Sexual excesses
render the renewal and perfect elimination of the seminal
fluid impossible; for although the secretion of this fluid is
constantly going on in the testes, the epididymis, seminal
ducts and seminal vesicles do no longer contribute their share
to the perfect restoration of the quality of the seminal fluid.
In some persons the fluid is repaired slowly, in others more
rapidly.  The more frequently the semen is discharged, the
more slowly is it repaired. I-ence, in consequence of disease
or of excessive emissions the semen loses its consistence,
specific gravity, odor, color, and scarcely stiffens the linen.
The microscope no longer shows a super-abundance of lively
spermatozoa.
The loss of the testicles is another chief cause of sterility.
As long as only one of the testicles is preserved, a sufficient
quantity of semen may still be secreted to carry on the pro



IMPOTENCE OF THE MALE.                239
cess of fecundation. Even after the removal of both testicles
by an operation, a sufficient quantity of semen may remain
in the vesicles for a time, to effect the fecundation of the
female ovum; for castration does not destroy the faculty of
procuring an erection.  But after a certain period, the impotence of the castrated individual becomes perfect.
The retention of the testicles in the abdominal cavity is
another cause of impotence and sterility of the male. As a
general rule the testicles do not descend into the scrotum
until the fetus has reached the age of seven months; if
they do not descend at this period, the virile powers may
be seriously impaired in after-life.  In such cases both
the internal and external organs are imperfectly developed,
the sexual appetite is exceedingly feeble, and sterility is the
natural consequence.  Sometimes only one testicle descends
and the other one remains in the abdominal cavity; or, instead of two, three testicles are present.  Such irregularities
do not prejudice the sexual faculty.
Diseases of the testicles constitute a tolerably frequent
source of sterility. We have already made mention of the
syphilitic sarcocele. Cancer and the medullary sarcoma of
the testicles likewise extinguish the fecundating power, These
disorganizations generally require to be removed by the knife,
and we therefore refer to works on surgery for the details of
such operations.
Tuberculosis of the testicles completely destroys the virile
power. Very frequently this is an original disease; it commences in the epididymis, and thence spreads to the seminal
vessels and vesicles, the prostatic gland and the lymphatic
glands belonging to the sexual system.  Sometimes the
disease spreads still farther.  It develops itself more particularly in young men affected with tuberculous dyscrasia, and
addicted to sexual excesses or self-abuse.
Impotence and sterility may likewise be caused by diseases
of the prostate gland, of the seminal vesicles and the ejaculatory ducts, and in general by whatever has a tendency to
weaken the fecundating powers or organs, or to cause sper



240                 SEXUAL EXCESSES.
matorrhoea; or by paralysis of the perinasal muscles which
contribute to the ejaculation of the semen.
Malformations constitute mechanical causes of impotence.
If congenital, the impotence is a permanent and irremediable
defect. But if merely acquired, or removable by an operation, the sexual power may often be restored by adequate
treatment.
Among congenital malformations we distinguish1. Smallness of the penis: All the rest of the organs being
normally developed, the penis  may nevertheless  remain
small-in consequence of various anomalous influences-and
therefore short, as is more or less the case in hypospadiasis
and in male hermaphrodites whose penis is not much larger
than the clitoris of the female. Evidently sexual intercourse
is impossible when the male organs are shrunk to this diminutive size.
A portion of the penis has sometimes to be removed by an
operation.  In such cases the power of fecundating the
female ovum is not always destroyed, inasmuch as a mere
ejaculation of the semen against the outer pudendum  is frequently sufficient to effect this result.
2. Hypospadiasis and epispadiasis: These defects consist
in fissures of the penis or rather of the urethra.  IHypospadiasis is much more frequent than epispadiasis. In the
former disease the fissure occurs below, in the latter on the
dorsum of the penis. The extent of the fissure is various,
especially in hypospadiasis. In hypospadiasis the fissure
may extend from the glans and involve only a portion of, or
the whole urethra, and even the scrotum; this malformation is
accompanied by a corresponding diminution of the size and
shape of the penis resulting from the fissure and smallness of
both the prepuce and glans.  In the higher forms of this
malformation the penis, by the complete absence of the prepuce, and the retreat of the penis into the fissure of the
scrotum, shrinks to the size of the clitoris, and, if the fissure
of the scrotum should take the outward form of a vagina,
may lead one to mistake one sex for the other.




IMPOTENCE OF THE MALE.                241
In former times such malformations were termed hermaphrodites. It was supposed that in such individuals both
sexes coexisted. In his legal medicine, Metzger mentions the
name of Maria Dorothea Derrier, whom some physicians' such
as Hufeland and Mursinna, maintained to be a female, and
others, such as Stark, Martens, Marc, a male. Malformations
of this kind generally result in impotence.
3. Atrophy of the penis is almost always accompanied with
atrophy' of the testes, and always causes impotence and
sterility.
4. Apparent diminution of the size of the penis: This
takes place in large scrotal herniae, sarcocele, hydrocele, and
may occasion impotence until the disorganization is removed.
5. Phimosis or excessive length of the prepuce may likewise lead to impotence. If the prepuce is so long and narrow
that it cannot be drawn back over the glans, the ejaculation
of the semen is impeded. Circumcision may restore the fecundating faculty.
Imperfeet or suppressed erections constitute a mechanical
obstacle to coit. This weakness mav result from abuse or in
consequence of severe diseases. It may likewise be owing to
a sort of paralysis of the corpora cavernosa, occasioned by
too frequent and too constant compression of the same, in
consequence of which their excitability is impaired and even
destroyed.  In such cases powerful excitants, such as cantharides, vanilla, beating with nettles, or the use of other
aphrodisiaca have to be resorted to in order to procure an
erection. This weakness is radically cured by the application of electro-magnetism, cold baths, douches, etc. Another
obstacle to fecundation is an excessive erection of the penis,
which results in a swelling of the mucous membrane of the
urethra, and consequent difficulty of ejaculating the semen.
A deviation of the erect penis from, the true line likewise
prevents its approach to the os tincae.  This defect arises
from an extreme shortness and tension of the suspensory
ligament of the penis, or of the frosnulum; or it may arise
from paralysis of one of the corpora cavernosa, or the condi



242                SEXUAL EXCESSES.
tions may resemble that of chordee in gonorrhoea. If the
frsenulum is too long, the glans is rather turned upwards, and
the penis is curved with the convex side underneath; if the
suspensory ligament is too short, the erect penis may almost
touch the abdominal walls.
The urethra may be closed up entirely by tumors on the
penis, indurations, condylomata, schirrous tumors on the
glans, swellings of the prostatic gland, large calculi; such
difficulties may give rise to impotence which could only be
cured by the removal of the original obstacle.  Strictures of
the urethra may likewise impede the passage of the semen
sufficiently to prevent fecundation.
Obstructions of the excretory ducts, or an abnormal alteration of their situation and direction may likewise lead to
impotence. Injuries or extirpation of the spermatic duct or
the seminal vesicles by cutting into the bladder through the
rectum may lead to the same results. The above-mentioned
obstructions cause the semen to be retained and to accumulate.  Generally this takes place on one side only, the
seminal duct in the spermatic cord and even the epididymis
swell, and a feeling of heaviness and a dragging sensation
are experienced, known to science by the name of spermatocele.
Congenital malformations of the sexual organs causing
impotence and sterility, cannot be removed by art. If here
weaknesses result from general debility, weakness of the
sexual organs, abuse of the sexual functions, they can be
cured, provided the patient sare in the hands of intelligent
and experienced physicians.
Homoeopathy possesses a variety of agents which have
been used with the best results in these affections.  The
proper selection of the remedy in such cases depends, however, upon a careful investigation of the general condition of
the patient and of all the symptoms characterising it. By
and bye we will furnish a list of these remedies and of their
symptomatic indications.  Previously, however, we  must
make mention of an agent of which we have seen the mo:t




IMPOTENCE OF THE MALE.                243
beautiful results in our practice, and which we have found
essentially to favor the employment and action of homeeopathic remedies; we allude to  electro-magnetism.   The
negative pole is applied to the sexual organs or to the
perinaeum, and the positive pole to the lumbar vertebra. In
some cases we have found it advisable to pass a current
through the parts while the patient was taking a bath. At
the close of the work we shall go into details concerning our
mode of applying electro-magnetism, and we will now furnish
a list of the homceopathic agents, of which we have successfully availed ourselves in the treatment of seminal weaknesses.
Acidum  muriaticum, in complete impotence, relaxation of
the penis, complete absence of all erections and a sense of
weakness in the parts.
Agnus castus, for frequent emissions, aversion or indifference to sexual intercourse, deficient erections.
Argenturn nitricumn: Deficient sexual desire, shrivelling of
the genital organs.
Camphora: Weakness of the parts, want of sexual desire
and erections, coldness of the parts.
Cannabis: Aversion to sexual intercourse, with coldness of
the genital organs.
Colocynthis: Complete impotence, complete loss of sexual
desire.
Conium  maculatum: Impotence, deficient erections, imperfect or short-lasting erections.
Ignatia amara: Impotence, with a feeling of weakness in
the hips.
Lycopodium: Aversion to intercourse of several years
standing, with impotence.
Mlagnesia carb.: Deficient erections, loss of sexual desire,
aversion to intercourse, no erection even when dallying with
a female.
Selenium: Impotence, with desire for coit.
Sulphur: Impotence, with amorous fancies.
Stramonium: Complete impotence.
Sabadilla: Relaxed penis, even with amorous fancies;




244                 SEXUAL EXCESSES.
insensibility to sexual excitement, averson to dallying with
females, diminished sexual desire.
Thuja: Indifference to female society.
V. STERILITY OF THE FEMALE.
Sterility occurs much more frequently in the female than
in the male.  The causes of sterility in the female are as
various as those of impotence, and may likewise be divided
into general, local, and relative causes.
Among the general causes we distinguish more particularly
such as relate to the whole body, and involve the coimposition of the blood and the nervous energy, viz: debilitating
diseases.  Hence sterility of the female frequently occurs
after sexual excesses, or in consequence of onanism, in which
case it is accompanied by a whole series of phenomena which
have been described already in the chapter on onanism.
There is a certain shape and development of the female body
which denote a disposition to sterility. Such women are of
slender make, their extremities are coarse and angular, the
sound of their voice is rough and hard, the mammae are
either wanting or imperfectly developed, the skin has a
darker hue and is covered with hair in places where they
generally exist in the male sex, as on the upper lip, chin, etc.
Considerable fleshiness is likewise a frequent cause of sterility; a lascivious disposition and excessive intercourse likewise prevent conception, as is seen in'the case of prostitutes.
Females who marry either too young or too old, are likewise
apt to be without children. There is scarcely a woman who
is entirely devoid of sexual desire; but even if this were the
case, she might yet conceive, considering that the part she
performs in the sexual act, is of a more passive nature.
Women in whom the sexual passion is less active, are more
easily impregnated, than women with strong sexual desires.
The same general diseases which cause impotence in the male,
lead to sterility in the female. The same remark applies to
the use of coffee, tea and other spirituous stimulants.




STERILITY OF TIIE FEMALE.                245
Among the causes of sterility which are inherent in the
condition of the parts, we number functional derangements,
diseases of the sexual organs, congenital malformations and
anomalies preventing either the sexual act itself or the fecundation of the ovum.
Diseases of the ovaries, inflammation, dropsy, hydatids,
fibrous tumors, schirrous indurations and osseous concretions
of the ovaries lead to the destruction of the ova, and consequently produce sterility.
If all the ovula are destroyed, conception is, of course, no
longer possible.
Not unfrequently a copious leucorrhoea is the cause of
sterility. In such a case it is important to ascertain the
exact locality of the leucorrhoeal discharge; for, if it arises
from the walls of the vagina, sterility is very seldom the
result of it, unless the thick and sour mucus should interfere
with the free movements of the spermatozoa.  If the discharge arises from  the neck or cavity of the uterus, the
mucus is still thicker, glassy like-albumen, stiffens the linen
and has an alkaline reaction.  After coming in contact with
this mucus, the movements of the spermatozoa are arrested
on the spot. This disease is frequently in the way of conception, but it can be removed.
There are various primary or consecutive diseases of the
uterus which are still more frequent causes of sterility.  In
consequence of other diseases the direction of the uterus may
be altered, so as to cause retro or anteversion of the uterus;
the os tincze may deviate from the normal line, so as to form
an angle with the body of the uterus; prolapsus and inversion of the uterus, destructive ulcerations of the substance
of the uterus, adventitious growths, such as: cysts, fibrous
tumors, polypi, osseous concretions, tubercles, cancer, and
frequently recurring metrorrhagiae are more or less frequent
causes of sterility.
The absence of the menstrual flow is likewise a cause of
sterility, especially if this anomaly arises from diseases of
the ovaries.  We know that an ovum  is secreted at every




246                 SEXUAL EXCESSES.
menstruation, and this seems to show that menstruation and
formation of the ovula are intimately connected. Generally
women lose their catamenia at the age of forty or forty-five
years, and cease to bear children; only in a few cases women
have still been impregnated after the cessation of the menses.
If the menses cease. prematurely in consequence of some
violent emotion, a cold, etc., sterility is very frequently the
consequence of such a suppression, and derangements of the
general health set in, which ordinarily point to diseases of
the ovaries.
It is a general rule that, if the first menses appear prematurely, they likewise cease again at an early age.
Sterility of the female is caused by a variety of malformations, either of the external or internal organs.
The external pudendum  may either be entirely wanting
or only imperfectly developed. Some parts of the pudendum,
such as the labia or clitoris may be too small; the entrance
of the vulva may be entirely obliterated or too large. The
labia or clitoris may, on the other hand, be excessively
lengthened, the nymphae may be abnormally multiplied or
too large and long.
The vagina may be completely or partially obliterated; it
may form a cul-de-sac of various shapes and sizes, having its
sacculated extremity somewhere in the interior of the vaginae
or it may terminate in the urethra. It may likewise assume a
hermaphroditical appearance, the clitoris being enlarged to
the size of the male penis, and the other parts being comparatively smaller than in the natural state. There may be two
vaginae, or the vagina may be divided into two canals by an
intermediate septum. In such a case the uterus may either
be compound or single.  Such a case has occurred to us
some time ago.  The speculum  penetrated both passages,
and, in each, showed an os tincee.
Entire closure or excessive narrowness of the vagina is
probably a congenital defect in most cases, but may likewise
result from large ulcers and cicatrizations. This defect may
either involve the whole or only a portion of the vagina.




STERILITY OF THE FEMALE.               247
Sometimes a second hymen is discovered in the vagina, a
dense membrane which of course arrests the introduction of
the semen.  Tumors in or near the vagina, occasioning a
contraction of the organ, likewise impede conception.
Malformations of the hymen, such as excessive hardness,
thickening, abnormal growths or interstitial distentions of the
hymen, may likewise oppose the fecundating process..Defects of the uterus.  Sometimes the os tince is closed
by a membrane, by which means not only the introduction of
the semen but also the discharge of the menstrual blood is
prevented, so that its accumulation in the uterus and the
consequent swelling of this organ may simulate pregnancy.
The os tincae may likewise be closed by plugs of mucus. A
conical shape of the os tincae is supposed to render sterility
unavoidable: in such a case it is very long, pointed, and its
orifice is scarcely perceptible.  The uterus may likewise be
entirely wanting. In such cases the vagina generally terminates like a cul-de-sac, although the general health of the
patient may be excellent. Generally such a defect is accompanied by a defect or an entire absence of the ovaries.
Defects of the Fallopian tubes.  In some cases their fimbriated extremities adhere to adjoining parts, in consequence
of which defect they are no longer able to embrace the ovary
and to receive the ovum after it had become detached.  This
defect is either congenital or it may arise from an inflammation of the peritoneum.  The tube may be very much contracted, or it may be closed at the extremities or in the
middle. Such a defect is either congenital, or it results from
an inflammation of the tube, or from an excessive secretion
of mucus in the tube, or from tumors existing either in or
near the tube. If the tubes are entirely wanting, in such a
case the ovaries are likewise wanting. The tubes may likewise be temporarily obstructed or contracted by mucus.
Beside these exceedingly important causes of sterility,
which it is sometimes impossible to remove, there are other
relative causes of sterility.
By relative causes we understand a variety of circum



248                 SEXUAL EXCESSES.
stances, which in spite of a perfect development of all the
organs, nevertheless prevent conception.  Such causes are,
for example, antipathy or antagonism between the married
partners; extreme differences of age, constitution and temperament, as when a very old man is married to a very young
wife, or vice versa, 4 very old woman to a very young husband; or when a cold and phlegmatic husband has a wife of
a very ardent temperament. Such causes are quite frequent,
although it is not always easy to find them out. There are
instances of sterility of five, ten or twenty years standing,
and where, after this period, conception took place in consequence of a change in the outward relations of the married
partners.  Henry II. had no children by the Duchess of
Urbain for ten years.  When he was on the point of separating from his wife, his friends advised him first to consult
the celebrated Doctor Fernell.  "Will you make my wife a
child?" asked the King, smilingly. " Sire," said the Doctor,
"you will have to do that, but I will tell you how."  The
Dodtor's advice being followed, the Queen indeed gave birth
to a child, and, on this occasion, made the doctor a present
of seventy thousand dollars, which was a very large sum at
that period.  Anna of Austria had been married to Louis
XIV. for fifteen years before she had a child. Baudeloque
mentions the case of a high personage who could not have
any children either by his wife or his mistresses. After an
absence of two years from France, his wife became pregnant,
and gave birth to a boy. After this, his wife again remained
without children for four years. After another absence from
France, his wife again had a child. The change of climate
was evidently the cause of the change in the condition of the
uterus.  By Baudeloque's advice he took a journey out of
France once a year, and by this means he became the father
of eleven children, five boys and six girls.
In former times, when sterility was noticed much more
than now-a-days, aversion of one of the married partners
against the other may have been a frequent cause of sterility.
In those times women frequently complained before a judge




STERILITY OF THE FEMALE.              249
that their husbands neglected to fulfil their matrimonial
duties.  This gave rise to the enactment, particularly in
France, that the sexual act had to be executed in the presence
of witnesses, in order that the ability of the husband might
be proved or disproved.
This statute is said to have originated in the proposal made
by a certain rake who was accused of impotence, to hold intercourse with a female in the presence of witnesses, and to
prove to them that he was not afflicted with impotence. This
proceeding became more or less general in the 16th century,
and the ecclesiastical tribunals resorted to it by statute in all
doubtful cases.
The lawyers, Guy de Chanliac and Vincent Tagereau, relate the following particulars in reference to this statute:According to Chanliac, husband and wife are to lie by each
other in the same bed for several days and nights, in the
presence of an experienced matron, appointed for that purpose by a physician employed by the authorities; this matron
is to exhort both parties to caress each other, etc., and was to
give them some elixir, and to fumigate their parts with some
ointment made of dry vine leaves; finally she was to report
to the physician what she had seen, and this one related the
facts to the authorities.
Vincent Tagereau, in his discourse on impotence, states
that in the suit of Treasurer de Bray, three physicians, three
surgeons, and three midwives, acted as jurors. Both parties
having sworn that they would honestly fulfil the matrimonial
duty without interposing any obstacles, and the jurors having
sworn that they would faithfully relate what had passed between the parties, these are conducted into a room where both
are carefully examined, from the vertex to the feet, in order
to ascertain whether there might be any natural obstacles to
the sexual act; the parts of the husband were washed with
tepid water, and the woman was placed for a while in a tepid
bath. After this, husband and wife lie together in the same
bed, the curtains are closed and the husband is requested to
fulfil the act. In one or two hours the jurors are either
17




250                 SEXUAL EXCESSES.
called or they come of their own accord, and examine the
female, in order to find out whether the thing had been accomplished.  The  proceedings are communicated to the
ecclesiastical tribunal.
It often happens that women who had no children by one
husband, have children by another one, and vice versa, that
husbands whom their wives accused of being unable to procreate children, have children by other wives. In 1653 the
Marquis de Langry married, at the age of twenty-five years,
Lady Mary de Courtomier, fourteen years old, and for four
years they lived together on the best understanding. In the
fifth year the lady charged her husband with impotence.
Experts declared that both parties were perfectly formed.
The lady, however, insisted upon her charge, and the marriage, in spite of all the efforts of the Marquis to the contrary, was declared null and void.  He afterwards married
Diana of Montault, by whom he had seven children.  Such
results have occurred and will continue to occur very frequently.
We do not consider it necessary, in order that conception
may take place, that the thrill should occur simultaneously
in both parties, but it is a settled fact that the nearer to the
menstrual period the sexual act takes place, the more certainly the women will conceive, because an ovum is already
detached at this period, and is on its way to the uterus. It
has likewise been observed that pregnancy takes place more
readily after the parties have been separated for a while, or if
they observe due moderation in the exercise of their matrimonial functions.  Among the orthodox Jews the women
generally, bear many children, probably owing to the fact
that the husband is not allowed to have any intercourse with
his wife for one fortnight after her menstruation.
The treatment of this disease is pretty much the same as
that of impotence.  A careful examination of both parties
and absolute confidence in the physician are indispensable to
a cure.  A variety of circumstances may sometimes operate
to bring about such a condition, and unless they are known,




STERILITY OF THE FEMALE.               251
it is impossible to remove them by treatment, provided, however, that no malformations are in the way.
The examination has to embrace the whole history of the
parties themselves, and even of the parents; the sexual
organs have to be subjected to a careful inspection.
It would be impossible to indicate a suitable treatment for
every case of sterility; the best method is to consult an intelligent and conscientious physician, who, after taking cognizance of every circumstance bearing upon the case, will
be best able to remove the difficulty.
We will mention a few general rules of treatment in order
to convince interested parties that a cure is often possible.
One of the most frequent causes of sterility is weakness of
the sexual organs and of the sexual functions, accompanied by
general debility; the former weakness generally arises from
abuse of the parts, the latter from sickness.
To remove the weakness of the organs, the patients will
have to avoid, for a time every thing that might excite the
organs.  The same diet will therefore have to be observed in
sterility that has been recommended for impotence.
Homoeopathic agents and electro-magnetism have likewise
proved very efficient in the treatment of sterility.  One pole
is applied to the parts, or even introduced in the vagina: and
the other to the spine, either in the lumbar region or sometimes in the region of the medulla oblongata.
The moral condition of the patient is of great importance;
with reference to such symptoms, Baryta, Conitum, Dulcamara, Platina, Sepia, or Sulphur, may be administered.
iConium  more particularly when the patient inclines to
sadness and is easily moved to tears by little trifles, or is disposed to feel vexed; Platina when the patient feels oppressed
with anxiety, or feels very cheerful one day, and low-spirited
the next; Sepia, for great sadness, disposition to find fault;
Sulphiur, for despondency, irascible disposition, forgetful.]
Congenital malformations are generally incurable.  If
sterility depends upon some local cause, this is frequently
removeable. Diseases of the ovaries and uterus, and more




252                  SEXUAL EXCESSES.
particularly leucorrhoca, can -be cured by proper treatment,
and the sterility caused by them, will likewise yield.
For chronic ovaritis, which is such a frequent cause of
sterility, we give at times Cocculus, at others Ignatia, especially if the patients complain of dull pains in the pelvic
region. If the disease is of long standing, and the patients
complain of dull, burning pains deep in the pelvis, Arsenicum
album is indicated. If the inflammation had been caused by
sexual excesses or by onanism, China, in conjunction with
electro-magnetism, will prove useful. If complicated with
nymphomania, Platina, Sepia or Sulphur may be exhibited.
Chronic affections of the uterus require: Arsenic., Cocculus,
Nux vomica, Platina and Sepia.
[Arsenic. for schirrus and carcinoma of the uterus, with
burning and shooting pains, discharge of foul and corrosive
sanguineous ichor;
Cocculus for uterine spasms, amenorrhoea, indurations of
the cervix;
Nux vomica: chronic congestions of the uterus, with burning  heat, heaviness, sticking and  pressure; contractive
uterine spasms, a griping and digging sensation, with discharge of clots of congealed blood; pressure towards the
genital organs, early in the morning, in bed, or during a
walk in the open air, with contraction in the hypogastrium;
excessive duration of the menses, a constant flow, but not
iery copious, or paroxysmal gushes of blood;
Platina for uterine hysteria, with intolerable titillation in
the uterus, or uterine disorganizations with symptoms of
putrescence;
Sepia, schirrous disorganizations of the cervix, discharge
of a purulent, foul matter.]




SPINAL IRRITATION.                  253
VI.-SPINAL DISEASES.
The spinal marrow is frequently involved in diseases of the
sexual organs, especially when such diseases arise from premature or unnatural sexual excesses.
Diseases of the spinal marrow manifest themselves either
as local affections, or in remote parts, most generally and
first in the lower extremities, urinary bladder, sexual parts,
etc. It is not our intention to furnish a complete treatise of
diseases of the spine, and we shall simply confine ourselves
to such as are intimately connected with the condition of the
sexual organs, and either result from or give rise to a derangement of the sexual functions. It is true, scarcely any spinal
disease does not exercise some influence on these functions,
but there are some spinal affections that are more immediately related to the sexual sphere.
SPINAL IRRITATION.
A pain or soreness of the spine is a frequent accompaniment of diseases of the sexual organs.  It is generally in
the lumbar and sacral region that the irritation of the spine
is seated.  It is accompanied by great excitability of the
sexual organs, erections, etc. This irritation of the spinal
genital nerves is generally. caused by hysteria, sexual excesses, onanism, leucorrhoea, carcinoma of the womb, gonorrhoea,
and urinary diseases. This kind of irritation is pretty common among the higher classes, especially that portion whose
minds and bodies have been subjected to the perverse systems
of education prescribed by fashion; it is known under the
comprehensive appellations of hypochondria and hysteria.
The symptoms are aggravated by disagreeable emotions,
luxurious living, stimulating drinks, menstrual derangements,
late rising, sleeping on the back, and sexual irritations.
The treatment is regulated  agreeably to the primary
causes of this disease.  Among the general means by which
the disease is removed, we distinguish: a strict diet, little or
k.  -.




254                  SEXUAL EXCESSES.
no meat, no spirituous beverages,' coffee or tea, perfect avoidance of all sexual irritations; frequent exercise in which
every part of the body is interested, regular and systematic
gymnastic exercises, country-air, travelling, short and calm
sleep, walking early in the morning, bathing in rivers, seabathing, hydropathic treatment, the use of electro-magnetism.
Of internal remedies we recommend: Acid. nitr., Acid.
phosphor., Arsenic., Belladonna, Bryonia, Calcar. carb.,
Chamom., Coffea, Colocynth., Cocculus, Conium, Causticum,
Ferrum, Graphites, Lycop., Nux vom., Opium, Pulsat.,
Rhus tox., Sepia, Sulphur, Veratr. alb.
[The selection of each particular agent depends in a measure upon the constitutional symptoms which characterize the
spinal irritation.
Aconite is one of the most admirable remedies for spinal
irritation characterized by soreness, lameness, weakness of
the back, shooting, boring, twitching, wrenching or crawling
pains, constant involuntary emissions, weakness of the sexual
organs, deficient erections, great sensitiveness of the organs
to the touch.
Acidum phosphoricum: Burning spot in the small of the
back, drawing and pressing pain in the small of the back,
hard swelling of the spermatic cord, loss of the sexual
desire, frequent emissions.
Calcarea carbonica: weakness of the back with great nervousness, excessive sexual desire.
Chamomilla: Drawing  or excessive  bearing-down and
pressing pain in the small of the back, down the thighs,
sexual excitement with itching of the scrotum.
Cocculus: La:ming and bruising pain in the small of the
back, tremor in the back, itching of the scrotum, violent pain
in both testicles as if bruised, increased desire for coit.
Conium: Stitches in the small of the back, with drawing
through the lumbar vertebrae when standing; spasm  in the
back; loss of sexual desire; loss of semen after the least
sexual excitement.
Lycopodium: Violent pain in the small of the back, with




SPINAL IRRITATION.                 255
stiffness, chilliness, loss of sexual desire, small, cold penis
with inability to become erect.
Nux vomica: Nightly pains in the small of the back;
beating pain in the small of the back, with eructations and
chills; contractive pain in the small of the back; tense and
sore feeling of the sacral and lumbar regions to the touch, or
pain in the small of the back and knees as if bruised and
contused; sudden stitch in the small of the back, when
endeavoring to turn to one side, with dull pain when sitting
perfectly quiet; constrictive pain in the testicles, nocturnal
emissions, continued and painful erections.
Opium: The sexual desire is violently excited, with lascivious dreams and emissions.
Pulsatilla: Aching pain in the small of the back as if
weary; stiffness and ulcerative pain in the small of the back;
contractive pain through the small of the back, or stitching
pain in the small of the back and abdomen, followed by a
creeping and drawing in the head, accompanied by vanishing of sight and hearing; the back is painful and stiff as a
board; the right testicle is drawn up and swollen, with swelling and tensive pain of the spermatic cord, or drawing-tensive
pains from the abdomen through the spermatic cord into the
testicles which hang down low; erections day and night;
emissions with excited sexual desire.
hius tox.: Pain in the small of the back as if bruised or
contused, when lying still, or sensation as if the part were
pressed against a sharp edge; tympanitic swelling of the
scrotum, with a good deal of itching; violent sexual desire,
with emissions.
Sepia: Weakness of the small of the back, with increase
of the sexual desire, and painful and violent erections.
Belladonna: Dull, distressing drawing round the whole
pelvis; intense cramp-pain in the small of the back and the
os coccygis, relieved by standing and walking; lancinations
in the testicles, they are drawn up; nocturnal emissions
without erections; perfect apathy when thinking of the other
sex.]




256                 SEXUAL EXCESSES.
TABES DORSALTS.
This is a disease of the spinal marrow in consequence of
which the muscular energy and elasticity gradually disappear, and which, from  emaciation of the long dorsal and
lumbar muscles, gradually leads to general consumption and
perfect paralysis.
Both sexes are liable to this disease, but more particularly
young men.  It is frequently overlooked in females, on
account of the greater delicacy with which their condition
has to be examined and inquired into. It is either the direct
or indirect consequence of sexual excesses, bodily fatigue or
cold.  The disease is sometimes preceded for years by symptoms of increased irritability and relaxation of the sexual
organs characterized by an inability to perform  the sexual
act, and by frequent emissions even in the day-time, and
various other signs of a general irritation of the spinal
marrow.
This disease commences with an unusual disposition to
weariness in the lower limbs and back, and an inability to
bear fatiguing exercise and to stand or stoop for a long time.
After a while the muscular sensations become altered; when
walking the patient fancies that he is stepping on fur or wool,
and that the floor is shaking or soft; hence, when walking,
he likes to stamp with the feet against the floor.  Gradually
the patient loses the faculty of properly using his muscles
without looking; in the dark, or while his eyes are closed,
he loses his sense of equlibrium, staggers to and fro, and
frequently consults a physician about his vertigo. When the
dorsum of the hand is extended on the table, small bodies
placed in the palm of the hand, are no longer perceived by
it; the patient is unable to button up his coat; all his voluntary motions are performed hastily and in an awkward
manner, because they are no longer directed by the muscular
sensibility and energy. The gait becomes unsteady, staggering, the knees give way from before backwards; if once




TABES DORSALIS.                 257
under way the patient is unable to arrest his steps without
holding on to something; hence he is unable to stop or to
turn about suddenly, and is greatly disturbed by trifling
obstacles. At last he has to be supported in walking. The
ischiatic processes and the iliac bones become prominent in
consequence of the emaciation of the dorsal and glutei muscles. Accompanying symptoms are: drawing and shooting
pains, creeping in the lower extremities and the back; sensitiveness of the skin to currents of air; relaxation of the
abdominal muscles, bladder and rectum; paralysis of the
sexual organs; sweats and herpetic eruption on the perinaeum;
pains in the abdomen and chest, dyspnoea, palpitation of the
heart, etc.
The treatment should aim above all things at removing the
causes of this disease; hence all physical excitation of the
sexual organs, and all lascivious fancies have to be carefully
avoided in order to allow the sexual organs as much repose
as possible.  Spices, and stimulating food and beverages
have to be avoided.  The patient should sleep on a hard
mattress, on the side, rise early, and never retain the urine
or stool.. In the first stage of the disease, gymnastic exercises, if carried on moderately and discreetly, may have
favorable results. Country-air, rural occupations, etc., are
likewise useful; afterwards cold baths, shower-baths, washing
the chest, back and sexual organs with cold water, vaporbaths and douches on the sacral region will be found eminently useful.
The diet should be nourishing and light: milk, milk-soups,
jellies, venison, etc.; whey should constitute a constant article of the patient's diet.
Internally the patient may use Aconite, Aciduzm phosphoricum, Arsenicum, Graphites and Lycopodium, especially
the three first named remedies, in the order in which they
are named.  The cautious use of electro-magnetism  is
attended with the best results.




258        DISEASES OF THE URINARY ORGANS.
Diseases of the Urinary Organs.
These diseases frequently exist independently of syphilis
or derangements of the sexual functions.  They are generally painful, troublesome and dangerous diseases, the rather
that many patients aggravate their condition by not applying to a physician in season.  Syphilitic diseases of the
urinary organs and of the prostate gland having been treated
in the previous chapters, we have only to describe the symptoms and indicate the treatment of such affections of these
parts as do not arise from a syphilitic cause.
I. RETENTION OF URINE.
By retention of urine we understand an inability to void
the urine.  This weakness is a symptom of many urinary
affections, and is frequently painful and attended with dangerous consequences; it may even endanger life, and should
be attended to as soon as it is perceived.
The causes of this disease may be divided into two groups,
one of which embraces all those influences which neutralize
the contractile power of the bladder; and the other, such as
prevent the emission of urine, although the contractile power
of the bladder is perfect.
In describing the anatomy of the bladder, we showed that
it is provided with muscular fibres, which enable it to contract
whenever an adequate stimulus is acting upon it. This contractile power of the bladder is one of its chief means of
voiding the urine, for the peritoneum and the diaphragm are
only indirectly concerned in the emission of urine, and would
be unable, in case the bladder were paralyzed, to expel the
urine. If the bladder is no longer capable of contracting,
we say that the bladder is paralyzed. This is always accompanied by a complete retention of the urine.  If the contractile power of the bladder is only weakened, the retention of
urine will only be imperfect.
Among the diseases which lead to the retention of urine,
we number: diseases of the brain and spinal marrow; exces



RETENTION OF URINE.                 259
sire distention of the muscular fibres of the bladder, which
takes place whenever, from  carelessness, forgetfulness, or
false modesty, the urine is retained in the full bladder beyond
a certain period; violent inflammation of the bladder and of
the adjoining organs; catarrh of the bladder; inflammation
of the peritoneum; difficult labor, during which the head of
the child remains for a long time wedged in the pelvis; fibrous
or schirrous disorganization of the walls of the bladder;
typhus and other acute fevers, during which the patients lose
their consciousness and allow the urine to accumulate in the
bladder and to remain in it beyond the normal period.
During the course of the diseases which we have mentioned,
the sentient nerves of the urinary bladder may become paralyzed, in consequence of which the desire to urinate would
no longer be felt; or the will-power ceases to influence the
muscles of the bladder, as, for instance, in affections of the
brain and spinal marrow; or the muscular fibres may have
become so relaxed and atrophied that they are no longer able
to perform their functions with regularity. In the former
case the patient ceases to be conscious of the necessity of
voiding the urine, and the sphincter vesicse, after the bladder
has become full and distended, loses its controlling power,
and the urine drops out during motion, like an overfilled
vessel when agitated. In the latter case, the bladder has no
longer the muscular energy required for the expulsion of the
urine.
Complete retention of the urine in the various diseases of
the kidneys, such as inflammation of the kidneys, Bright's
disease, etc., occurs less frequently.
The second group of the causes of retention we class mechanical obstacles which impede the flow of urine, although
the bladder m.ay be possessed of its full contractile power.
These obstacles act partially from without, compressing the
urethra and the neck of the bladder, and thus preventing the
urine from flowing out.  In men the urine may be retained
in the bladder by large hernia, swelling of the testes and
scrotum, accumulation of the foeces in the rectum, or con



260        DISEASES OF THE URINARY ORGANS.
striction of the penis by means of a cord which is tied round
the part by some young men for the purpose of preventing
involuntary discharges of urine in bed during sleep; it was
not long since that we were called to such a case.
In the case of women, retention of urine generally sets in
in the fourth month of pregnancy and during parturition; it
may likewise be caused by polypi in the uterus; fibrous tumors and schirrus of the uterus; changes in the position of
the uterus, such as retroversion or anteversion; curvature
and prolapsus of this organ; or incrustation of a pessary in
the substance of the womb.
Mechanical obstacles may likewise act from  within, by
closing the canal as with a plug. This may be effected by
stone, gravel, coagula, hydatids, mucous plugs, or foreign
bodies which had penetrated into the bladder, such as pieces
of bougies, catheters, pencils, and such like objects, which
children sometimes introduce into the urethra for fun, and
which then glide forward into the bladder.
Other mechanical obstacles are alterations of the tissue of
the urethra, such as mucous valves at the neck of the bladder; swelling of the prostate gland; strictures; absence of
an orifice at the outer extremity of the urethra; closing or
constriction of the prepuce; engorgements of the veins on the
neck of the bladder, which very frequently co-exist with
haemorrhoidal tumors and varicocele.
We generally distinguish three degrees of retention of
urine, and designate each degree by a particular name;
1, dysuria, the emissions of urine being simply difficult, with
or without pain; 2, strangury, the urine being discharged
only in drops, in spite of the greatest efforts; and 3, ischuria,
or complete inability to emit urine.
The affection commences in various ways.  Sometimes it
sets in suddenly in all its intensity; at other times it is preceded by various kinds of distress, the stream is feebler and
thinner, or the urine is discharged in drops, there is a frequent urging to urinate, and only a small quantity of urine
is discharged each time.




RETENTION OF URINE.                 261
If the retention is complete, the patient experiences a
sense of heaviness in the perineal region, urging to stool
without inability to gratify it, acute pains above the symphisis pubus; these pains extend as far as the kidneys and
glans.  These symptoms are accompanied by a feeling as if
the thighs had gone to sleep; the pains are worse when
walking, coughing or rising from  a chair; they abate on
stooping forward, because then the abdominal muscles are
relaxed. There is a constant desire to pass urine, the patient
is constantly agitated and in motion. All endeavors at voiding urine, are fruitless. After a while, nausea and an anxious oppression of breath set in. The face and eyes become
red, palpitation of the heart, fainting, sweat and vomiting
set in. The bladder fills more and more, and rises up to the
pit of the stomach, forming a visible tumor which presses
upon the viscera.  Gradually the urine is absorbed in the
circulation, a violent fever, delirium and sopor develope themselves. If the retention has reached this degree, death generally ensues either by inflammation of the bladder and other
abdominal viscera developing themselves, or also in consequence of the rupture of the bladder and an effusion of urine
into the abdominal cavity.  The urethra may likewise get
ruptured, and an infiltration of the urine, into the cellular
tissue may take place, causing inflammation, suppuration and.
even gangrene; an inevitable consequence of this suppuration are urinary fistulae, several of which frequently make
their appearance in the neigborhood of the rupture.
If the retention takes place very gradually, an enormous
quantity of urine may accumulate in the bladder; it may
even pass upwards into the ureters, the pelvis of the kidneys,
and even enter the fine urinary ducts in these organs.
Although it is not very difficult to diagnose a retention of
urine, yet an involuntary dribbling of urine may sometimes
be mistaken for an inability to retain the urine, whereas, in
reality, it is owing to the fact that the bladder is overfilled,
and that the urine flows out, as it were, in a similar manner
as any other vessel would flow over when agitated.




262        DISEASES OF THE URINARY ORGANS.
In order to establish a correct diagnosis, it will\ therefore
be necessary to institute a careful examination of the case
by the following means: 1, palpation of the abdomen and of
the region of the bladder, in order to find out whether a firm
or fluctuating tumor has developed itself any where; 2, percussion of the abdomen with the plessimeter, which, if the
bladder is full, will yield a dull and faint sound in parts
where a clear bowel-sound is usually heard; by means of
percussion we have it in our power to determine the size of
the bladder and to distinguish it from  the other viscera.
3. Anexamination should be instituted from the rectum  or
the vagina, in which case the examining finger will discover a
tense swelling like a bladder, and 4, a catheter may be introduced, which will at the same time alleviate and frequently
remove the difficulty.
It is of the utmost importance to ascertain the real cause
of the disease; for unless we know the exact cause, it would
be impossible to effect a cure.
If the retention should arise from an accidental delay in
not at once satisfying the desire to pass urine, a single introduction of the catheter will remove the trouble. [I have
found that in such cases the application to the bowels of a
bandage dipped in cold water, causes an immediate contraction of the bladder and consequent discharge of urine, without resorting to the catheter at all.-ED].
In cases of imperfect contraction or paralysis of the
bladder, the urine has to be drawn off with the catheter
which is then allowed to remain for twenty-four hours in the
bladder.  This treatment is frequently sufficient in imperfect
paralysis of the bladder such as it apt to occur in the case of
old people.
The principal remedies for retention of urine arising from
complete or partial paralysis of the bladder, are: Acid.
nitr., Cannabis, Cantharides,  Causticum, Clematis, and
Pulsatilla.
[To these remedies may be added Aconite and Arsenicum,
especially if the patients are very nervous and restless, tor



RETENTION OF URINE.                 263
mented by anxiety, and the urine passes off in drops, looks
dark, bloody, has a strong odor.  Aconite is particularly
suitable to hysteric females, or in cases arising from taking
cold, a sudden fright, a strain.
Cantharides may be given if the paralysis is accompanied
by violent urging to urinate, and if it remains as a consequence of inflammation of the bladder or kidneys.
Pulsatilla is more particularly adapted to females or persons of mild and lymphatic temperament.]
In desperate cases electro-magnetism will be found an
excellent remedy..We apply it in the following manner:
A silver catheter is introduced into the bladder for the purpose of emptying it, and is allowed to remain in the bladder;
a similar catheter is introduced into the rectum; both poles
of the battery having been brought in contact with the extremities of the catheters, the electric currents were conveyed
to the walls-of the bladder.  By gradually increasing the
electric action, fifteen applications were frequently sufficient
to cure the disease completely.
If the paralysis is caused by inflammation of the bladder,
a careful homoeopathic treatment will be found sufficient to
cure the disease without resorting to the introduction' of the
catheter.  This is a great advantage; for not only is the
introduction of the catheter under those circumstances difficult, but it is well, if the irritation which always accompanies
the introduction of the instrument, can be avoided. If fever
should be present, Aconite will be found sufficient to subdue
both the fever and the disease, and if a dull pressure or
burning at the neck of the bladder should still remain
behind, Nux vomica will remove these symptoms.  Other
symptoms may happen to require
Arsenicum, Baryta carbonica, Belladonna, Bryonia, Cannabis,  Cantharides, Capsicum, Carbo  veget., Helleborus
niger, Veratrum.
Arsenicum: Great urging to urinate, the urine is burning, looks bloody.
Belladonna: Retention of stool and urine; the urine




264        DISEASES OF THE URINARY ORGANS.
comes off in drops, of a natural color, or else of a gold-yellow
color.
Cannabis: Paralysis of the bladder; the urethra is closed
with mucus and pus.
Cantharides: The urging to urinate is accompanied with
great pain, icy-coldness of the hands and feet.
If the retention is owing to a spasmodic closing of the
neck of the bladder, one of the following remedies has to be
chosen:
Acidum phosphor., Arsenicum, Belladonna, Calcar. carbon., Carbo veg., Canthar., Conium, Graphites, Telleborus
niger, Ignatia, Lycopood., Nux vomica, Platina, Pulsatilla,
Staphysagria, Sulphua, Zincum.
[Aconite: Violent urging, anxiety, pain in the region of
the bladder, congestion of blood to the head, redness of the
face. If this remedy should not relieve, give
Cantharides, especially if the pains are cutting and tearing.
Arsenic.: As if the bladder were too full.
9gnatia: Sharp pressure on the bladder as from  flatulence.
Nux vomica: Painful, ineffectual desire to urinate, without
fever.
Pulsatilla: Ineffectual desire to urinate, in nervous, hysteric females, or persons of gentle and yielding disposition.
Sulphur: Inability to urinate, especially in children, who
are troubled with worms or have been deprived of exercise.]
If the retention is owing to mechanical causes, they have
to be removed: hernia have to be reduced, accumulations of
faeces, tumors, and foreign bodies have to be removed;
abnormal positions of the uterus have to be remedied. The
mechanical manipulations which may be required for such
purposes, are materially assisted by the exhibition of Aconite, Arsenic., Belladonna, Cocculus, Ipecacuanha, Laurocerasus, Nux vomica, Sulphur and Veratrum.
[Aconite, Cocculus and Nux vomica are of peculiar benefit
in hernia; Aconite more particularly when inflammatory




URGING TO URINATE.                 265
symptoms are present; in general Aconite, and sometimes
Coffea, will be found indispensable adjuvants in surgical
operations to quiet the nervous excitement and subdue the
supervening inflammation.)
If prolapsus of the uterus is the cause of the retention,
the same remedies that have been mentioned for hernia, will
be found useful, and moreover: Calcarea carb., Petroleum,
Platina and Pulsatilla.
If all these remedies and manipulations should fail in
removing the retention, and if the excessive distention of the
bladder should threaten a rupture of this organ, in such a
case the bladder will have to be punctured with a trocar, the
instrument being introduced through the perinaeum, or above
the symphisis pubis or through the rectum, according as the
surgeon may deem advisable.
Having saved the patient from immediate death, we then
proceed to remove the cause of the retention; having succeeded in this, we then heal the wound as speedily as possible.
If the cause cannot be removed, the artificial passage for
the urine will have to be kept open; to meet such an emergency, it would be advisable to perform the operation above
the pubis, because a metallic instrument could easily be
retained in this region through which the urine might be discharged.
In the case of women the operation may be performed
either through the vagina or above the symphisis pubis.
II. Too FREQUENT URGING TO URINATE.
Although this trouble is not a disease properly speaking,
yet it is a very unpleasant weakness to which old people are
more particularly liable. A frequent urging to urinate, with
or without actual discharge of urine, is often experienced by
persons who live in a good deal of company or who lead a
sedentary life. The urging increases more or less gradually,
but a'resistance to the desire to urinate is exceedingly distressing. If the emission of urine is postponed too long, it
18




266        DISEASES OF THE URINARY ORGANS.
sometimes becomes impossible to emit a single drop, and the
patient has to press upon the bladder for a long time, after
which the urine comes off first in drops and finally in a continuous stream.
This abnormal desire to urinate may be perfectly painless,
but it is frequently accompanied by a sense of heaviness in
the region of the bladder, a peculiar sensation of muscular
spasms in the perineal region, pains and burning in the neck
of the bladder, contractions of the anus, and very frequently
a spasmodic, periodical urging as far as the glans where a
very unpleasant itching is experienced. If the patient succeeds in voiding the urine, it first passes off by fits and starts,
after a while the stream  become continuous, and the last
drops are rather painful.  In other cases there are no pains,
and the patient is only troubled with frequent urging which
is gratified without any'pain being experienced. The affection generally developes itself gradually. After it has lasted
for a while, the patients begin to feel uneasy about it and
fancy that they are affected with some more deep seated
trouble, such as gravel, stone, stricture of the urethra, etc.,
and the physician has the greatest trouble, by means of
explanations and  persuasive  eloquence, to remove these
apprehensions.
The causes of this trouble may be various.  One cause
may be the extreme smallness of the bladder, which, being
unable to hold much urine, has to be emptied very frequently.
Some persons are in the habit of voiding the urine as soon as
the least desire for doing so is felt; in this way the bladder
gradually loses the faculty of distension, so that it becomes
unable to hold any considerable quantity of urine. One of
the most frequent causes is an excessive sensitiveness of the
neck of the bladder, and of the sphincter vesicse.  This
portion of the bladder being naturally vascular and richly
supplied with nerves, it is of course sensitive, and this sensibility admits of being considerably heightened by influences
calculated to induce a determination of blood to this region.
A cold, for instance, especially when arising from  exposure




URGING TO URINATE.                  267
of the feet, may give rise to an excessive urging to urinate;
every body may know that a cold bath, or exposure of the
feet to cold stones, increases the desire to urinate.  This
trouble is likewise occasioned by the excessive use of tea,
black coffee, stimulating beverages and spiced food; by an
inflammatory irritation of the mucous membrane of the
bladder and urethra, by blennorrhoea of the urethra, irritating
injections, strictures, abuse of bougies, also by the presence
of stone and renal calculi; by habitual costiveness, irregularities of the intestinal canal, irritations of the rectum by
piles, ascarides, etc.
Females are frequently subject to this trouble, in consequence of anomalous menstruation; acuminated condylomata
in'the interior or on the outside of the urethra, may likewise give rise to this affection.
The treatment should of course aim  at removing the
exciting cause, and regulating the diet. Tea, coffee, stimulating beverages, spiced food, have to be avoided; in general
the patient should not distend the bladder by too much
liquid previous to retiring to bed. The principal remedies
for this weakness will be found to be
Acidum  nitr., Calear. carb., Cantharides, Causticum,
Conium, Graphites, Kali carbon., Lycop., Natrum muriat.,
Pulsat., Sepia..
[Aconitum will prove an admirable remedy for this affection, if it arises from a cold or a sudden emotion, such as
fright. If Aconite should not afford any relief,
Dulcamara may be used, for similar causes.
Cantharides will help, if the urging is painful, the pain is
cutting and tearing.
Pulsatilla, if the weakness is accompanied by a mucous
discharge from the urethra. In chronic cases
Sepia and Lycopodium may be used.]




268        DISEASES OF THE URINARY ORGANS.
III. INCONTINENCE OF URINE, INABILITY TO RETAIN THE
URINE.
The inability to retain the urine, and the constant involuntary dribbling of the urine is a much more disagreeable,
troublesome and loathsome weakness than the former.  The
urine passes off in drops, without any urging, sometimes
without any sensation, and without interruption, or else the
last-mentioned affection attains simply a higher degree of
development and the bladder fills to such an extent that it
flows over, as it were. In either case the sphincter vesicse is
weakened or paralyzed, and the muscular fibres of the body
of the organ act so much more vigorously or alone. If the
sphincter is entirely paralyzed, the urine generally passes
out of the bladder as soon as it enters it.
The disease occurs most frequently among old people, or
among such persons as had grown old prematurely in consequence of excessive living; the weakness of the bladder
generally arises from excessive irritation of the spinal marrow, and may often be considered a symptom  of incipient
tabes dorsalis.  In middle-aged persons the trouble may set
in in consequence of diseases of the brain and spinal marrow,
hernia, injuries of the vertebrae, fall of the perinaeum, or
during excessive intoxication, fainting, convulsions, and in
hysteric persons.  In some cases the weakness commences
even in childhood.
This disease is not dangerous, but exceedingly disagreeable,
loathsome; the clothes are soaked with urine, and a pestiferous odor of urine surrounds the patient. Such patients are
a burthen to themselves and others, and have to shun all
company.  In spite of the greatest cleanliness they are
troubled with a burning and itching, redness and soreness of
the parts moistened by the urine.
A variety of this affection is nocturnal enuresis or wetting
the bed, which generally occurs among children, but sometimes also among full-grown people.  I have treated girls
and young men of from seventeen to twenty years old for such




INCONTINENCE OF THE URINE.              269
a weakness.  It arises from a relaxed state of the bladder.
In some the urine escapes involuntarily in consequence of
their sleeping too soundly. Such persons have to be roused
two or three times in the night, in order to accustom them
to regular emissions of the urine.  Others fancy that they
are using the chamber, whereas, in reality, they are wetting
their beds; such persons should likewise be roused very
frequently.  There  are some who  from  sheer laziness,
prefer wetting the bed to getting up and using the chamber.
In such cases punishments or exposure may have to  be
resorted to.
The treatment should be conformable to the particular
causes of the weakness. If it depends upon other diseases,
it will disappear with them. If the patients are children,
they should eat and drink little at supper, and should be
made to void urine previous to going to bed. Children should
never sleep on their backs, but always on their sides or
stomachs; for, in these positions, the urine is less apt to irritate the bladder and bring on contractions of this organ.
In the case of girls, the trouble generally continues until
they get married.
If the weakness is owing to excesses, these have to be
avoided, and the weakness of the sphincter vesicae has to be
removed by specific remedies.
If the weakness arises from paralysis of the sphincter, we
usually apply electro-magnetism  with great success, and
accompany the application of this agent by the internal
exhibition of Carbo veg., Causticum, China, Conium, Natrum
muriat., Petroleum, Rhus tox., Sepia, Sulphur.
[To these remedies we will add Aconite, Digitalis and
Mercurius.
Aconite is a great remedy for this weakness, in the case of
hysteric females, when the urine is quite pale and watery, or
when the affection was caused by a sudden fright, a cold, or
by previous, mismanaged inflammation.
Digitalis, when the weakness is accompanied by irregularity
of the heart's action, dizziness, sluggish pulse.




270        DISEASES OF THE URINARY ORGANS.
Mercurius, watery urine, frequent urging in- the day-time,
costiveness, the stools being hard, lumpy, dark-colored.
China, will be found useful if the trouble was caused by
excessive losses of animal fluids, onanism, sexual excesses.
Carbo veget. may be resorted to when children seem to be
troubled with worms, or in case of acidity of the stomach
alternating, or existing simultaneously with palpitation of the
heart.
Sulphur is one of the most important remedies in this
affection; in the day-time there is a constant desire to void
the urine, and the patient wets his bed every night. I once
treated a young man of sixteen years, who had wetted his
bed every night two or three times for several years past;
the urethra had expanded into a sacculated swelling, and for
several months past the patient had slept on hard boards, in
spite of which the urine passed off every night. He was
radically and permanently cured with eight powders of the
first centesimal trituration of Sulphur.]  If no cure should be
possible, the patient will have to wear a reservoir made of
caoutchouc, into which the urine may collect.
VI. HEMATURIA, BLOODY URINE.
This affection usually befalls persons of an advanced age,
and men more frequently than women.  The blood which is
discharged together with the urine, may emanate from various
portions of the uropoetic system, the kidneys, ureters, bladder and urethra.  This disease is scarcely ever an idiopathic
disease, but generally a mere symptom of some other malady.
The cause may be general or local.
Among the general or constitutional causes we distinguish
an alteration in the composition of the blood, as in scurvy,
purpura haemorrhagica, severe typhus, typhus putridus; or the
blood may be passed with the urine in consequence of the
suppression of regular discharges, such as the piles or catamenia.  Some females, after their menstruation ceases, pass
blood with the urine. According to Peter Frank, one half
of those who are troubled with bloody urine, are addicted to




BLOODY URINE.                    271
intoxication.  This trouble may also be one of the consequences of onanism and sexual excesses.
The local causes of haematuria are various: injuries of the
kidneys, bladder, ureters, urethra, especially by stone or
gravel; contusions and shocks in the region of the kidneys
or bladder by a fall or strain; continual riding on horseback,
concussion of the body in a badly contrived vehicle, over bad
roads, full of ruts, violent exertions in raising a heavy load,
during severe labor, coit, or when vomiting; forced marches;
abuse of violent cathartics or aphrodisiaca, such as cantharides or drugs that bring on miscarriage; also vesicatories
applied to the region of the kidneys or bladder, etc.
Bloody urine is passed in nephritis, or in organic diseases
of the urinary passages, gravel, stone, cancer or medullary
sarcoma of the kidneys or bladder, ulcerations of the bladder,
varicose disorganizations of the mucous membrane of the
bladder, etc.
In Bright's disease, especially in the commencement of the
malady, and in scarlatina, the urine is likewise frequently
bloody.
Haematuria is frequently preceded by congestions of the
organs from which the blood proceeds, characterized by such
symptoms as: heaviness, dull pain, drawing in the lumbar
region and other symptoms of affections of the kidneys, if
the blood proceeds from the latter organ; anomalous sensations in the region of the bladder, strangury, if the blood
flows from the bladder.
If the bloody discharge is caused by injuries in the region
of the kidneys or bladder, or by a fall upon the perinaeum,
the blood is generally pure and red provided there is no urine
in the bladder at the time.  From the appearance of the
blood it is impossible to determine with correctness from
what organ the blood proceeds.  If the blood emanates from
the kidneys or ureters, the blood is generally mixed with
urine, and the bloody discharge is generally accompanied by
the above-mentioned symptoms.  If the blood comes from
the bladder, the patient experiences a sense of fulness, pres



272        DISEASES OF THE URINARY ORGANS.
sure, urging and a crampy feeling in that region, a burning
sensation in the urethra, erections, and if the haemorrhage
should be considerable, the extremities grow cold, the face
pale, and fainting turns supervene. In such a case there is
no intimate commingling of the blood and urine, and the
blood is deposited on the bottom of the vessel in flocks and
coagula.  Very frequently these coagula fill up the bladder;
and, by stopping the orifice, cause strangury and even complete retention of urine.  If the difficulty arises from stone
in the bladder, the first urine is generally clear, but the
latter portion of the urine becomes bloody.
The urine may continue bloody even after the cause of the
hemorrhage had been removed for some days. This is owing
to the fact that the dark-red fibrine of the coagula which had
become lodged in the bladder, are gradually carried off by
the urine.  After this dark-red fibrinous matter has been
removed by the urine, the remaining pale-red fibrine generally passes off in a vermicular form, giving rise to the belief
that worms are discharged from the bladder.
Bloody urine is not always painful.  In some cases but
very little blood is passed, but sometimes the quantity is so
considerable as to endanger life, especially if the haemorrhage set in suddenly and copiously.
In treating this disease we. have to consider the nature and
causes of the disease.  All spirituous beverages, all substances which tend to excite the sexual appetite and to bring
on miscarriage, all sexual excesses, self-abuse, etc., have to
be strictly avoided. If the disease is not caused by inflammation, but by sedentary habits and by obstructions in the
portal system, by suppression of piles or menses, the patient
should take frequent exercise in the open air in order to
promote the circulation, and to remove the abdominal congestions.  Stone in the bladder and calculi in the urethra
have to be removed by a surgical operation.
Internally the following remedies have to be given: Calcar.
carb., Cantharides, Mercur. sol., Mezereum and Pulsatilla.
LIn this list the most important agent for the cure of this




GRAVEL AND CALCULI.                 273
affection has been omitted, and this is undoubtedly Aconite.
I do not believe that any drug known to us is better able to
remove obstructions in the portal system than Aconite, and
to cure the diseases which arise from such obstructions, among
which bloody urine is very commonly met with.  The discharges are generally attended with a burning and stinging
sensation in the urethra, and the patient is apprehensive of
evil consequences, looks frightened, sallow. It is likewise
adapted to.the bloody urine of hysteric females, or when the
discharge arises from suppression of the menses, haemorrhoids, or from a cold. If there should be an intense, distressing and frequently-recurring urging to urinate, Cantla-?ides may be tried instead of the Aconite, which, by the by,
should be given in the form of tincture, and, after the distressing urging or the pains are relieved, and the urine continues slightly bloody, mixed with pus or mucus, Pulsatilla
may be employed; these three agents will be found sufficient,
to control almost every case of this disease.]
V. GRAVEL AND CALCULI IN THE URINARY PASSAGES.
These are little bodies which are precipitated from the
urine as it cools, and are deposited on the bottom of the
vessel.  Generally the deposit is composed of small crystals
discernible to the naked eye.  Sometimes it is a fine pulverized sediment; sometimes this sediment contains small
calculi.
Generally this affection is the first degree of stone, and
accompanied by gout and rheumatism.
Gravel forms in the kidneys, the finest canals in which are
filled with it. Very frequently gravel only consists of urate
of ammonia, with or without free urea; its color is generally red, and the urine in which it is contained, mostly
reacts like an acid.  There.are several kinds of gravel distinguished from  each other by their color, size, number,
shape, surface, consistence, position and chemical constitution. Beside red gravel, we have gravel which is red-brown,
yellow, brown, gray-white or ash-colored.  The size varies




274        DISEASES OF THE URINARY ORGANS.
from the finest sand to that of a pea. As regards the shape,
the larger grains of gravel are at times round, at others oval,
oblong, compressed in various ways, pear-shaped, cylindrical,
cordiform, prismatic, etc. Their surface is at times smooth,
at others facet-shaped, or rough and uneven.  In regard to
consistence, we observe differences depending upon the chemical constitution; at times the gravel is soft like pap, at
others hard as stone. -Most frequently gravel is composed
of urate of ammonia, sometimes of mere urea, or of ammoniacal phosphate of magnesia, or oxalate of lime.
Some individuals are predisposed to the formation of
gravel, and in others this predisposition  is hereditary.
Parents affected with stone or gout, generally transmit to
their children a disposition to gravel or stone.
The arthritic diathesis is closely related to the formation
of gravel in the kidneys; a paroxysm  of gout is frequently
preceded by a discharge of gravel from the urethra. Rayer
observed that among one hundred gouty individuals ninetynine were at the same time affected with gravel. In children scrofulosis and rickets seem to be allied to the formation of stone.
It has been observed that in some regions gravel and
stone occur quite  frequently, whereas they are  almost
unknown in other regions.  Some have attributed the existence of these diseases in such regions to the use of sour
cider and sour wine, of food containing a large quantity of
nitrogen, to the nature of the water and to various other
causes. But all these causes likewise exist in other places
without being attended by the same consequences.
The formation of gravel, especially of the kind of which
uric acid is the chief element, is undoubtedly eminently due
to the mode of life of the individual. It can be shown by
experiment that a rich, nitrogenized dry food increases the
quantity of uric acid, in the urine, whereas the contrary
results from the use of simple, moderate food which contains
but little nitrogen. Gravel occurs therefore most frequently
among those who are addicted to rich living, to the use of




GRAVEL AND CALCULI,                 275
meat, strong wines, etc.  Patients who are affected with
gravel, generally feel worse after an excess at dinner, whereas
moderate living renders the disease comparatively harmless.
There are substances, such as cheese, which is an indigestible article, any how-whose nitrogen greatly contributes
to the formation of uric acid. Sour food and sour drinks
likewise favor the development of gravel; their acid passes
into the urine and thus favors the formation of uric acid.
The formation of gravel is likewise promoted by such
derangements of the urinary apparatus as impede the emission of urine.  Among these diseases we number principally
weakness and paralysis of the bladder, swellings of the prostatic gland, strictures, a habit of retaining the urine, rest,
late rising in the morning, and all such diseases as impede the
freedom of motion, such as articular rheumatism, fractures of
bones, etc.  Women are less frequently attacked by this
disease than men.
Patients who are afflicted with gravel, the chief constituent
of which is an urate, frequently complain of sour, rancid
eructations after dinner, sometimes of canine hunger, flatulence, costiveness, hypochondriac mood; indiscretions in
eating are followed by restless nights, a feeling of malaise in
the abdomen, drawing pains in the shoulders and nape of the
neck.  The vascular system  is irritated, the pulse is full,
hurried, there is headache and dizziness. Frequently pains
are experienced in the lumbar region, and along the urethra;
the emission of urine is accompanied by pains and spasms,
and the urine contains a little blood together with the gravel.
Sometimes these symptoms alternate with regular attacks of
gout or piles, during which the above-mentioned symptoms
abate; or else the gout and piles abate while the urine
deposits the red gravel, and, after a while, again reappear.
Sometimes the symptoms of gravel are confined to local
affections of the urinary organs, pains in the loins which are
aggravated by bodily exercise and by excesses; pains in the
region of the bladder, frequent urging to urinate, itching and




276        DISEASES OF THE URINARY ORGANS.
pain of the orifice of the urethra, discharge of blood with the
urine, etc.
If the basis of the gravel is a phosphate, the constitutional
symptoms are more deep-seated; the digestive functions are
impaired much more, the appetite is entirely gone, the stomach is distended by flatulence, costiveness alternates with
diarrhoea, the stools are fetid. Other symptoms are: general
prostration, a small, feeble, and sometimes hurried pulse,
extreme irritability, emaciation, cachectic appearance and
depression of spirits.
The prognosis in gravel is most favorable when there is
no hereditary disposition, dyscrasia, or organic disease of the
kidneys or other organs; and when the formation of gravel
is restrained as much as possible by suitable diet, regime and
the use of remedial agents. The uriate is more easily cured
than the phosphate which generally depends upon some
organic disease. Gravel composed of the phosphate of lime,
is the worst form of gravel, for it is generally accompanied
by organic diseases of the mucous membrane of the kidneys
or bladder, and by an increased secretion of mucus from these
parts.
The cure of this affection is most materially assisted by
strict diet, which is sometimes sufficient to arrest the formation of urates in the kidneys. We know from  experience
that such patients had better abstain from the use of animal
food, and confine themselves to refreshing drinks, and use
such bodily exercise as will promote the action of the -skin.
Robust persons who had lived on meat principally, will often
be able to arrest the gravel-diathesis by confining themselves
to vegetable diet exclusively. All heavy food, such as cheese,
heavy  farinacious compounds, food which is disposed to
engender acids, which contains a good deal of saccharine
matter, and is consequently disposed to ferment, wines, more
especially sour wines, have to be avoided. The cutaneous
action should be promoted by warm clothes, and frictions,
by avoiding every kind of exposure to colds, by warm baths,
shower-baths and by bodily exercise.




STONE.                      277
The following remedies may be used internally: Belladonna, Cannabis,  Capsicum, Colchicum, Galcar.  carb.,
Lycopod., Mezereum, Sarsap., Uva ursi.
[Belladonna may be given, if the urine looks gold-yellow,
the kidneys feel sore, warm, with sense of fulness and constriction.
Cannabis: Inability to pass the urine, it looks bloody, the
urethra is filled with pus.
Colchicum: The disease is complicated with chronic rheumatism, gout.
Sarsaparilla: The patient had taken much mercury under
alloeopathic treatment, or the urine contains a good deal of
white, acrid and turbid matter, and is passed with a good
deal of tenesmus.
Uva ursi: The urine contains blood and pus.]
VI. LITHIASIS, STONE.
This is a more perfect degree of the former weakness; a
stone arises from the gradual combination of several calculi
into one coherent mass.
Calculi are generally located in the pelvis of the kidneys,
in the calices and in the medullary, very rarely in the cortical substance. They are of various sizes and frequently
exist several together.  Sometimes these unite into one, are
of various shapes, round, oval, or without any definite form,
rough or smooth, etc.  The chemical composition influences
the form of these concretions, especially on their surface; the
oxalates are generally provided with pointed elevations, the
phosphates have a rough, and the urates a smooth surface.
The calculi frequently contain a nucleus of coagulated
blood, of urate of ammonia or oxalate of lime, around which
the remaining layers of the concretion are concentrically
arranged.
The causes of lithiasis are the same as those of gravel.
By inducing chronic inflammations of the urinary passages
and catarrh of the bladder, calculi favor the developments of
the lithiatic disease; for the mucus which is secreted in in



278        DISEASES OF THE URINARY ORGANS.
creasing quantities, causes the calculi to adhere more and
more.
Foreign bodies in the bladder are very apt to become the
nuclei of stones. Little fragments of pencils, needles, kernels,
hair, bougies, probes, etc., are known to have become such
nuclei.
Calculi, like gravel, are found in various parts of the
urinary organs.
The phenomena of lithiasis are almost the same as those
of gravel; only more developed and more intense, and more
frequently accompanied by distressing and alarming symptoms.  Colica renalis frequently occurs, if one or more calculi
penetrate the orifice of the ureter and are pressed downwards
into the bladder. This kind of colic may likewise be caused
by violent concussions, movements, riding in a carriage or
on horseback, coit, spirituous beverages, diuretics, etc., very
frequently it occurs at periods when attacks of gout habitually
take place in the spring and fall. The pains suddenly rise to
an intense height, causing even convulsions.  They do not
remain confined to the lumbar region, but extend through the
abdomen towards the bladder; this whole space sometimes
becomes so painful that the least contact causes the patient
to scream. Frequently the pains spread to the pubic and
sexual regions, as far as the tip of the glans.  They are
generally accompanied by retention of urine and a painful
urging to urinate; amid violent tenesmus only a few drops of
red, black urine, which is mixed with blood and mucus, are
emitted.
Beside colica renalis, lithiasis is frequently complicated
with haematturia and nephritis.
A stone in the bladder has to be removed by means of an
operation, either lithotomy or lithotrimy. For a description
of these operations we refer the reader to the works on
surgery.




CATARRH OF THE BLADDER.                279
VII. CATARRH, OR BLENNORRH(EA OF THE BLADDER.
This chronic affection' of the bladder very frequently remains after an acute disease; it is frequently caused by other
organic diseases of the bladder, prostate gland, or urethra;
or it may occur as an idiopathic disease.
The most essential symptom of this disease is the secretion
of a considerable quantity of mucus which is discharged from
the bladder together with the urine. As long as the disease
remains in its first stage of development, the urine simply
appears turbid, and the mucus which is mixed up with the
urine, gradually falls to the bottom of the vessel in the shape
of a whitish, whitish-gray, transparent layer, whereas the
urine above it clears up. Very frequently the mucus floats
about in the urine in the shape of flocks and filaments. If
much mucus is secreted, which is more generally the case, the
urine becomes thick, the mucus is frequently white, yellow,
green, and may constitute a considerable portion of the
urine; it goes down as a tenacious, gelatinous, lumpy substance, which is drawn out into ropy filaments upon the urine
being poured fron one vessel into another. At first the
urine preserves its acid reaction; as the mucus increases in
quantity, the reaction becomes alkaline; from being inodorous
its odor becomes ammoniacal and offensive, and decomposition
takes place very rapidly. Inasmuch as the mucus goes down
while the urine is in the bladder, it may happen that the
urine which passes out first, is clear, and that it is only the
last portions of the urine which is mixed with mucus. Sometimes the urine contains a little blood and albumen.
The emission of urine generally takes place imperfectly.
Instead of flowing in a rapid and full stream, the urine
passes out very slowly. Sometimes the stream is interrupted
suddenly, and after many vain exertions, a plug of mucus is
expelled, after which the urine flows out again more easily.
At night especially the patients are roused from sleep by a
desire to urinate; very often they have to urinate every half




280        DISEASES OF THE URINARY ORGANS.
or every quarter of an hour; they feel a pain in the region of
the bladder, urethra and perinaeum. The urinary emission is
frequently preceded by a spasm in the bladder which increases
while the last drop of urine is being pressed out, and then
disappears again.
If the blennorrhoea lasts for a time, the general health of
the patient becomes affected; the digestion is impaired, the
patients complain of constipation, pains in the loins, they
have a cachectic look, grow thin, are attacked with fever in
consequence of not sleeping and losing so much mucus; the
lower extremities become oedematous, and general dropsy
frequently sets in.
In some rare cases paralysis of the bladder takes the place
of the spasm.  The secretion of mucus remains unaltered,
the alkaline urine flows continually, but only in drops and
involuntarily from the distended bladder; very frequently
symptoms of absorption of the urine into the general circulation develope themselves, and this condition may easily terminate fatally.
If the first symptoms of the disease are overlooked, a
cure  becomes much more difficult.  Season, climate and
regime have great influence upon this disease. In the summer
a cure takes place much more readily, but a relapse is always
a thing often to be apprehended.
The obstinacy of the disease renders the prognosis somewhat doubtful, although no actual danger exists except when
paralysis of the bladder takes place or the urine.is absorbed
by the blood. The causes of this affection are numerous and
varied.  Old people are particularly liable to it.  Men are
more frequently affected in this way than women, especially
leucophlegmatic, scrofulous and arthritic individuals; individuals addicted to an effeminate and luxurious mode of living,
and to sedentary habits, to the use of spirits, or afflicted with
abdominal plethora, literary men, tailors, shoemakers, etc.,
are particularly liable to catarrh of the bladder. The disease
is quite frequent in low districts, damp regions, along the
sea-coast in Holland and England.




CATARRH OF THE BLADDER.                 281
Among the exciting causes we notice
a. Organic diseases of the bladder, prostate gland and
urethra, which lead to an increased secretion of mucus in the
bladder, such as: stone, ulceration and carcinoma of the
bladder, swelling of the prostate gland, scrictures of the
urethra, etc.
b. Irritation of the mucous membrane of the bladder by
acrid urine;
c. Mechanical and chronic irritation of the bladder by
frequent introductions of the catheter, attempts at lithotrimy,
irritating injections into the bladder, etc.
d. Colds, and abnormal atmospheric influences, such as
cold and damp air, low and marshy regions, etc.
e. Piles and gout are frequent causes of catarrh of the
bladder, especially of the male sex, who are frequently troubled
with this disease.
Sexual excesses, abuse of certain kinds of beverage, such
as new beer, new wine, strong claret, the use of cantharides,
turpentine, may likewise lead to this trouble.
A radical cure is seldom possible.  An intelligent physician
will therefore aim at making the patient as comfortable as
possible, and prolonging his life by a carefully regulated diet
and regim'e.  Such patients should live in dry, high, sunny
and airy. dwellings; they have to avoid the damp morning
and evening air, and in general every kind of humidity.
They ought to dry their clothes well by the fire before putting them on; it is a good custom for such patients to wear
flannel next to the skin in order to moderate the action of
the atmospheric air upon this organ, and promote the cutaneous exhalation.
The diet maybe nourishing, but it should be moderate.
Spiced, salt and smoked food, sour fruit, sour, fermenting
beverages have to be avoided. Fresh meat, vegetables that
contain a good deal of saccharine matter, water and sugar, a
little claret in water at dinner, and farinaceous food may be
allowed. Pure wine and spirituous beverages should be prohibited.
19




282        DISEASES OF THE URINARY ORGANS.
The urinary secretion should be a chief point of attention
with the attending physician; if it is not perfectly regular,
it will have to be regulated. Before voiding the urine in the
night, the patients should rise and walk up and down the
room a few times in order to prevent the mucus from going
to the bottom of the bladder. The habit to void the urine
kneeling, should not be indulged in, inasmuch as it promotes
the disease; at any rate this is the opinion of distinguished
physicians. If the stream should be suddenly interrupted,
the patient should not press hard, for a little shaking, or a
change of position are sometimes sufficient to restore the
flow. If the bladder should not be completely emptied, the
remaining urine will have to be drawn off by means of a
catheter, in order to prevent it from becoming alkaline and
irritating the bladder still more.  Catheters made of caoutchouc or gutta percha are the best for this purpose.  The
catheter should not be introduced too frequently, because this
might likewise increase the irritation.
In the first stage of the disease, especially when frequent
relapses take place, Mercurius sol., Belladonna and Pulsatilla will be found excellent palliatives, and in a few rare
cases [yoscyamus.  In the further course of the disease we
have to resort to Capsicum and HKelleborus.  If these remedies afford but temporary relief, Carbo veget. may be tried.
In the case of scrofulous persons Conium, Dulcamara and
Staphysagria may be exhibited. If spasms, urging to urinate
and excessive sensitivenes of the bladder supervene, Belladonna, Cannabis, Cantharides and Digitalis may prove serviceable.  Colocynthis and Sabina will be found suitable to
arthritic patients.
In very chronic cases Argentum, Calearea carbonica,
Graphites, Lycopod., Mangan. acet., Magnesia  muriat.,
Natrum carbon. may still be of some use.




HYPERTROPHY OF THE BLADDER.              283
VIII. HYPERTROPHY OF THE BLADDER, THICKENING OF THE
BLADDER, WITH DILATATION OR CONTRACTION OF ITS CAVITY.
Hypertrophy of the bladder with dilatation frequently
developes itself imperceptibly, so that the patient is not
aware of any trouble until the urinary discharges are interfered with. The distended bladder forms a painless globular
swelling above the pubes. Its exact position and the fact
that it is full of urine, can be ascertained by percussion.
The urging to urinate is experienced more frequently than
usual, the emissions of urine become troublesome, and the
stream is weaker. The bladder is never completely emptied,
and, after the urine is voided, the organ remains apparently
distended above the pubes, where it is felt as a tense, somewhat moveable body.  The urine, especially if the bladder is
at the same time affected with chronic inflammation, is turbid,
purulent, and has a strong ammoniacal odor. The distended
and hypertrophied bladder occasions a sense of heaviness in
the pelvis, a pressure at the perinseum, on the rectum, difficulty of passing stool, a pressure on the sacral nerves, a
feeling of numbness and even paralysis of the lower limbs.
In hypertrophy of the bladder with contraction, the organ
scarcely holds a few ounces of urine, and the patient is
unable to retain even a small quantity of this fluid; he has
to pass urine every few minutes. Even after voiding the
urine, the patient still feels as though the bladder were full.
Even by means of the catheter but a small quantity of urine is
drawn off. The urine is turbid and has a strong ammoniacal odor.
These two forms of hypertrophy, although secondary
affections, yet may cause other disturbances such as catarrh
of the bladder, inflammation and suppuration of the bladder,
dilatation of the superior urinary passages, of the ureters,
pelvis of the kidneys, gangrene of the mucous membrane of
the bladder and peritonitis; some of these conditions may
have a fatal termination.




284        DISEASES OF THE URINARY ORGANS.
The disease generally occurs among older people.  The
causes of hypertrophy of the muscular fibres of the bladder
are frequently recurring, catarrhal irritations of the mucous
membrane of the bladder, stone in the bladder, mechanical
obstacles to the free emission of urine arising either from
diseases of the prostate gland and urethra, or from hypertrophy or displacement of adjoining organs, carcinoma or
prolapsus of the uterus, etc.; violent and repeated gonorrhoea in former years.
The treatment can only be palliative. The causes of the
trouble, catarrh of the bladder, swelling of the prostate
gland, strictures of the urethra, external tumors, have to be
removed or palliated.
The regimen and diet should be the same as have been
indicated for catarrh of the bladder.
Calcarea carb., Carbo veget., Conium, JEuphorbium, Graphites, Lycopodium, Sulphur and Tlhuja may be administered internally.
[In selecting a remedy for this disease we have to survey
the whole ground covered by all the symptoms that can be
traced as having had any bearing upon the existing group of
morbid phenomena.. If we can trace any connection between
the disease of the bladder and irregularities of the heart's
action, Aconite and Digitalis may prove excellent palliatives;
if the affection of the bladder seems to be traceable to derangements of the mucous and glandular systems, Mercurius
vivus and Calcarea carb. may be exhibited; if the vegetative
system seems especially disturbed, as manifested by derangements of the digestive functions such as acidity, heartburn,
costiveness, brick-dust or whitish sediment in the urine, Calcarea and Carbo veget. may prove useful. Mercurius and
Thuja will be found serviceable if the hypertrophy seems
connected with previous syphilitic or sycosic diseases, diseases of the prostate gland, etc.]




SPASM OE THE BLADDER.                 285
IX. SPASM OF THE BLADDER.
A spasm  of the bladder may either be a mere symptom
characterising one of the above-mentioned diseases, or it may
be an idiopathic disease, of a purely nervous character,
without any organic alterations.
In the latter case it generally sets in suddenly.  The
patients, frequently towards the end of an urinary emission,
experience a violent, constrictive pain in the region  of
the bladder, especially in the perinaeum, which  extends
into the urethra, and, in the male, spreads to the superior portion of the penis towards the glans; sometimes
it is accompanied by painful erections and extends to the
groins, testicles and thighs. Frequently it is accompanied
by painful tenesmus of the sphincter ani, involuntary stool
and prolapsus of the rectum.  The perineum  and lower
region of the abdomen are sensitive to pressure, hot and distended.  The pain which sets in in paroxysms, generally lasts
only a few minutes, never more than from  fifteen to thirty
minutes.  It is accompanied by a painful urging to urinate
which cannot be satisfied.  When the spasm  abates, a full
stream of urine is frequently emitted. On account of the
excessive irritability of the bladder, it is extremely difficult
to introduce the catheter. The urine is generally clear and
paler than usual. A violent spasm of the bladder is accompanied by anguish, restlessness, trembling, general nervous
paroxysms, cold sweat, a small and contracted pulse and
vomiting.
This disease may attack persons of any age and of either
sex; females, and persons of middle age are most -frequently
subject to it.  Nervous, irritable, hypochondriac and hysteric
persons are particularly predisposed for this affection.
Exciting causes are emotions, anger, mortification, exertions of the mind, irritation of the urinary and sexual organs
by cantharides, diuretics, new wine and beer; retention of




286        DISEASES OF THE URINARY ORGANS.
acrid urine in the bladder; sexual excesses, colds, sitting on
damp, cold ground, etc.
The treatment of this disease has to aim at the removal of
the exciting cause; at the same time we may prescribe one
or more of the following remedies according to the symptoms;
Acidum  phosphor., Arsenicum, Belladonna, Calcar carb.,
Cantharides, Carbo veget., Conium, Graphites, Helleborus,
Ignatia, Lycopod., Nux vomica, Platina, Pulsatilla, Staphysagria, Sulphur, Zincum.
[To these remedies may be added Aconite, when the spasm
is caused by a cold, exposure to dampness, suppression of
sweat, or when it is a symptom of hysteria.
Among the above-mentioned remedies, Pulsatilla, Nux
vomica and Cantharides may be considered as chiefly adapted
to this affection.
NTux vomica, when the spasm is accompanied by a painful
desire to urinate.
Pulsatillt, when the spasm is characterized by a constrictive sensation in the region of the bladder, tenesmus of the
bladder, with involuntary discharge of a little urine.
Cantharides, excessive urging to urinate, with cutting and
tearing pain in the region of the bladder.]
It is a matter of course that the regime and diet of the
patient should be regulated with great care, as in all other
diseases of the urinary organs.




SYPHILISATION.                  287
SYPHILISATION.
Before concluding our remarks concerning syphilis, we
will allude to the method introduced in France of inoculating
the syphilitic poison for the purposes of arresting the ravages
of this disease; it has even been asserted that secundary
syphilis has been radically cured by this means.
This method of inoculating the syphilitic virus, has been
termed syphilisation, and the discussion concerning this subject is not yet closed.
For this reason we forbear expressing a critical opinion
about it, and content ourselves with giving the historical outlines of this method from the commencement to the present
period.
On the 30th of September, 1844, Dr. Auzias Turenne,
laid before the French Academy of Sciences, a communication that he had successfully inoculated a monkey with the
syphilitic virus, and on the 5th of November, 1844, such a
monkey was exhibited before the Academy, and on the 20th
of November another monkey to the Chirurgical Society.
Dr. Auzias Turenne intended to show by his experiment that
the pus of a primary syphilitic ulcer produced the same disease in animals as well as in men, and that therefore the
opinion that syphilis is a disease which exclusively affects the
human race, is erroneous.
By repeating these inoculations with the syphilitic virus,
chancres finally ceased to be reproduced, and this gave rise
to the theory that the animal was no longer susceptible to
the syphilitic disease, and that the same relation obtained in
the case of this animal between its constitutional condition
and the syphilitic virus, as between the small-pox virus and
a vaccinated individual. By transferring this theory to man,
the conclusion was arrived at, that repeated inoculations of
the syphilitic virus in man, produced the same insensibility
to its effects, as existed in the case of the monkey, and might
be resorted to as prophylactic means against the syphilitic




288                  SYPHILISATION.
contagion.  It was afterwards supposed that such repeated
inoculations might likewise be employed as curative means
where the syphilitic disease had actually broken out.
On the 30th of June, 1851, the following communication
from  Dr. Auzias Turenne was read before the Academy of
Sciences.
"On the 11th of November, last year, I informed the
Academy that I had succeeded in discovering by experiments
upon animals a species of prophylactic inoculation against
syphilis, which I have termed syphilisation for the reason
that the organism is impregnated with the syphilitic virus. I
then added that experiments on man had induced me to
believe that the same process would lead to the same results
in his case that I had observed in the case of animals, and
I have now to report that I have been unceasingly engaged
since that period in verifying the results of my theory.
At this period experiments concerning this subject are
being instituted in large hospitals, and some of my statements
have already been confirmed. Nevertheless I deem it proper
not to promulgate the facts which have been collected thus
far, until they have been-confirmed by abundant testimony;
I will content myself with laying before the Academy the
contents of a paper which was read on the 22d of May last
before the academy of Turin by Dr. Casimir Sperino.
The author who was surprised at the uniformity of the
results which had been obtained by both of us, undertook to
repeat my experiments. For this purpose he selected fiftytwo prostitutes in his wards of the hospital for syphilitic
diseases, who were more or less affected either with primary
or secondary syphilis. In these fifty-two cases the chancres
became the less active the more frequently they were reproduced in the same individual until it finally became impossible to reproduce any.  There was no exception to this
rule."
Moreover it was found that serpiginous chancres, obstihate
ulcers of the fauces, fluctuating buboes, figwarts and other
more dangerous syphilitic phenomena, would yield to the




SYPHILISATION.                  289
action of the syphilitic virus if properly applied. Neither
mercury nor iodine was used.  This method had excited so
much confidence in Turin that several prostitutes presented
themselves before Dr. Sperino, in order to be syphilised,
either for the purpose of being cured of the disease, or of
being protected against it.  "It frequently happens, says
Dr. Sperino, that patients who were averse to syphilisation,
now beg me to subject them  to this treatment."  It is
attended only by a few slight inconveniences which can
easily be avoided.
Sperino closes his report with the following remarks: " The
question now is whether those women who are no longer susceptible to the action of the syphilitic poison, remain so for
ever, or only for a time? Whether the cure of the primary
and secondary syphilitic disease will prove permanent and
radical? These questions can only be solved by time and
careful observations.
So far it is a positive fact that all those patients who
were received in our hospital for the last five months, and
who were saturated by me with the syphilitic virus, have not
only remained free, without an exception, from secondary
symptoms, but that their general health steadily improved
from the moment when the first acute chancre was produced
in them, up to the time when the treatment was concluded."
" It is likewise certain that successive inoculations with the
syphilitic virus remove rapidly all the primary and secondary
syphilitic symptoms, and it seems to me that such results are
sufficiently important to claim our most serious attention."
Sperino's observations have been conducted with remarkable tact and sagacity, and they show that no preconceived
opinions should deter us from instituting similar experiments.
We will now communicate to our readers in 51 propositions the results of the method of syphilitic inoculation as explained by Dr. Auzias Turenne, in No. 48, of November,
1853; as to the value of the statements contained in these
51 propositions, we forbear expressing any opinion for the
present.




290                   SYPHILISATION*
1. There is but one syphilitic poison although it may
emanate from various sources; but its effects vary; we may
therefore adopt several degrees of syphilitic toxication.
2. An individual who is capable of resisting the action of
the lower degrees of this poison, need not necessarily be
capable of resisting the higher degrees.
3. All other circumstances being equal, the character of
the virus descends in degree the further the process of syphilisation is carried, and the more extensive the surface from
which the virus is secreted and the larger the quantity.
4. A poison which ceases to affect one person, may still be
able to affect some other person who is less thoroughly
syphilised, and particularly one who had not yet been inoculated at all.
5. If a perfectly healthy individual is inoculated with a
poison of the higher degrees, the first chancre will be very
considerable.  The subsequent chancres will be less active,
especially if the virus is taken from the same individual, and
the pus which is secreted by these subsequent chancres, will
be of an inferior quality. The more frequently the process
of inoculation is repeated in the same individual, the more
thoroughly the organism  becomes impregnated with the
syphilitic virus.
6. The virus taken from  an individual that had been
repeatedly inoculated, acts with less intensity not only upon
the same individual, but likewise, although not to the same
extent, upon others not yet inoculated.
7. This virus of a less degree is obtained by repeated inoculations of the same individual in a state of health, and, after
the second or third inodulation of that same individual results
in the production of the most inveterate chancre, viz: the
indurated or Hunterian variety.
8. Those who believe that, at a certain period, the chancrous virus is no longer transmissible by inoculation, should
have considered the double cause of this want of transmissibility.




SYPHIILSATION.                   291
Namely, a. The alteration which the chancrous virus undergoes in consequence of the process of inoculation in the same
organism'; b. The diminished sensitiveness of the organism
to the homogeneous virus to be inoculated.  These two circumstances lead to a perfect insensibility of the same individual to the action of its own virus.
9. Every chancre has a period of decrease during which
it can be inoculated in every body in the same degree and
form.
10. All inoculated chancres have the same tendency to
cicatrise, and they do cicatrise provided its tendency is not
neutralised by some incidental influence.
11. Chancres of the largest dimensions, which are generally likewise of longest duration, require the most time to
accomplish the process of cicatrisation.
12. The extent and duration of the cicatrisation may likewise be influenced by the locality of the chancre.
13. Chancres of the same date but of different origin, in
one and the same individuals, may, especially in the commencement, show entirely different degrees of vitality corresponding to the quality of the virus which had been employed for the production of the chancre.
14. Two chancres of the same origin and date, in different
individuals, may exhibit different degrees of action inversely
proportionate to the syphilisation which had been effected in
them.
15. Later chancres produced in the same person, may be
much more considerable than former ones, if the virus which
caused them, is more intense.
16. Even the weakest virus is still capable of affecting
persons who had never been syphilitic.
17. If a person ceases to be sensitive to the action of an
inferior virus, he may still be sensitive to the action of a virus
of a higher degree.
18. This virus may then still continue to produce two or
three successive chancres in the same person.
19. If a person is inoculated with a virus of a higher




292                   SYPHILISATION.
degree than that which is secreted from  actually existing
chancres, the virus which is obtained from these new chancres, is not, on this account, superior to the former virus.
20. By thus renewing the production of chancrous virus
in the same person, we finally secure him completely against
all syphilitic contagion.
21. The best and quickest mode of thoroughly impregnating an individual with chancrous virus, consists in effecting
several successive inoculations with a very powerful and continually renewed virus; this method is, however, attended
with pain, and care has to be had to prevent the chancre
from becoming phagedemic.
22. The following is the best mode of syphilising a person
who had never yet been syphilitic: a. by.means of a single
puncture pus of a lower degree is inoculated, after which the
same person is inoculated with his own virus every eight days,
and afterwards even still more frequently, until the person
ceases to be any further affected by it; 6. afterwards the
inoculations are repeated on the same person with virus of a
higher quality and at shorter intervals.
23. If a person is affected with chancre, the virus of this
chancre may be taken for the purpose of inoculation, and the
process may then be continued as described above.
24. For persons affected with constitutional syphilis the
same process is adopted as for those who had never been
tainted with syphilis, with this difference, that virus of a
higher degree is substituted as soon as the lower virus ceases
to act.
25. The puncture should be as direct and superficial as
possible, so as to secure the smallest possible size of the
chancre. The first chancrous pustule is exactly proportionate
in size to the solution of continuity effected by the puncture;
hence the more direct and superficial the puncture, the less
extensive the chancre.
26. Syphilisation is a source of strength to the organism;
it increases the appetite and the assimilative power of the
organism.  This method may likewise be employed against




SYPHILISATION.                  293
other diseases; we know from experience that it has been
advantageously resorted to against cancer.
27. Gonorrhoea and phymosis are sometimes, not always,
symptomatic diseases; these are prevented by syphilisation,
and they are cured in every case where the purely syphilitic
character of the disease has not been replaced by an irritation of a catarrhal character.
28. They may be caused by an inferior virus as primary
symptoms, in which case they may be said to be a commencement of syphilisation; or else they may be produced by a
superior virus in an organism previously tainted with syphilis.
29. In the former case the inoculation may be successively
repeated on the same person; in both cases persons who are
not tainted, may be inoculated.
30. Venereal excesses which limit the action of the poison
to a smaller number, likewise diminish its intensity.  In persons who had never been tainted, chancres spread with great
rapidity.
31. Chancres which do not cause constitutional syphilis,
are a. such as are caused by an inferior virus, and are termed
primary chancres; b. such as are produced in persons undergoing the process of syphilisation, and whose organisms have
been thoroughly impregnated with the syphilitic virus; in the
former case the germ is deficient, in the latter the organic
susceptibility.
32. Thy secondary phenomena are caused by the constitutional infection, and are results of the diminished quality of
the virus secreted by an indurated chancre. These secondary
phenomena may be compared to the multiplied chancres of a
person undergoing the process of syphilisation.
33. A person affected with constitutional chancre, cannot
be inoculated with virus of an inferior quality, although a
healthy person may be inoculated with it.
34. Syphilisation not being a pathological condition, it'
cannot be effected or transferred by injections of blood.
35. The infecting power of the chancrous virus is not proportionate to the extent of the chancre,




294                   SYPHILISATION.
36. The virus of a phagedenic chancre keeps its quality as
long as the chancre remains phagedenic.
37. In order to control a phagedenic chancre by syphilisation, a virus of a higher or lower quality than that of the
chancre, has to be employed.  A pus that can be readily
absorbed, should be principally used.  A  pus which is not
readily absorbed, assumes a phagedenic character; pus which
is readily absorbed, acts as an anti-syphilitic prophylactic,
the more efficiently, the higher its quality or degree.
38. The effect of this syphilitic pus is not always the same
in the different stages of the chancre from which the pus is
secreted.
39. After inoculation the chancre developes itself the more
rapidly the more thoroughly the individual had already been
subjected to the process of syphilisation.
40. The condition which, according to circumstances, is
variously, and at certain periods, developed in certain individuals who had remained free from constitutional syphilis,
disappears again in consequence of the successive modifications produced by subsequent chancre.
41. In order to remain perfectly free from  all primary
symptoms of syphilis, it is necessary to subject one's-self to
a thorough process of syphilisation; this process, however,
need not be carried to a very high degree if nothing else is
desired than to be guarded against general syphilis.
42. Persons thoroughly inoculated with  the syphilitic
virus, are' no longer able to produce it; the source, from
which either primary or secondary symptoms spring, is
drained.
43. No constitutional symptoms of syphilis result from
syphilisation; on the contrary, if any such exist, they disappear in consequence.
44. A. chancrous cicatrix is just as susceptible to the
syphilitic virus as any other part of the skin.
45. Syphilisation is not effected locally; if one portion of
the body is under the influence of the syphilitic virus, the
whole body is.




SYPHILISATION.                    295
46. The prophylactic effects of syphilisation are not transitory, nor are they idiosyncratic.'47. Animals are less susceptible to the syphilitic virus
than men, although not all of them in the same degree. A
dog, for instance, is less susceptible than a rabbit; a rabbit
less than a cat; a cat less than monkeys in general; we say
in general, for some monkeys are more susceptible than cats.
48. A man undergoing the process of syphilisation, passes
through these various degrees of susceptibility.
49. The less an animal or man is naturally or artificially
susceptible to the syphilitic virus, the more powerful the
virus has to be which we use for purposes of inoculation. A
non-observance of this rule is the cause of the frequent failures in attempting to inoculate men or animals, and of the
secondary symptoms which have been frequently developed
in men.
50. The syphilitic virus in its various degrees is the best
standard by which the existing susceptibility to the syphilitic
virus can be measured.
51. Syphilisation upsets both practically and theoretically
all existing theories concerning syphilis.  The opposition to
the doctrine of syphilisation is directly proportionate to the
amount of false theories which it does away with.




296               ELECTRO-MAGNETISM.
APPENDIX.
ON ELECTRO-MAGNETISM AND ITS CURATIVE VIRTUES IN VARIOUS DISEASES
IN GENERAL AND AGAINST SEXUAL DISEASES AND THEIR CONSEQUENCES
IN PARTICULAR, ACCORDING TO THE METHOD WHICH I HAVE FOLLOWED
IN THE TREATMENT OF THESE DISEASES FOR A NUMBER OF YEARS.
Electricity and magnetism  are. physical forces which,
although they have been known from time immemorial, and
notwithstanding the astonished progress of the physical
sciences, still produce a great many inexplicable and mysterious phenomena.  The wonderful properties of the electromagnetic telegraph are known to every body, and demonstrate
in the most incontrovertible manner the marvellous forces of
these two imponderable substances.  These forces, being
known even to the physicians of the earlier ages, were employed already by them for therapeutic purposes.
The electrical machine and the Leyden battery were the
first instruments of this kind that were employed for various
diseases, and even for the resuscitation of persons apparently
dead. But the impracticable nature of an electrical machine
which could not be carried by the physician from patient to
patient; the violent effects of such a machine and of the
Leyden battery soon drove electricity out of the materia
medica, and caused it to be abandoned entirely.In 1790, Professor Galvani of Bologna, discovered that,
while suspending frogs' legs, denuded of their integuments,
from an iron railing by means of small copper hooks, these
legs were thrown into brisk convulsive twitchings as often as
a current of air caused them  to touch the railing.  He
accounted for this phenomenon by supposing a peculiar fluid
(a so-called animal electricity,) whom he located in the nerves
and which he supposed was transmitted by the metallic bodies
to the muscles at the moment when these came in contact with
the iron.
Galvani's discovery led to a variety of investigations which,
however, did not advance the knowledge of the cause of




ELECTRO-MAGNETISM.                 297
these phenomena, until Volta, professor at Pavia, repeated
Galvani's experiments with particular care, and became convinced that the convulsions were more particularly excited
when the conducting medium between the nerves and muscles consisted of two metals, the surfaces of which in those
places where they were in contact with each other and with
the legs of the frog, had to be metallic throughout.  Volta
taught that the heterogeneous metals during their contact
become charged with opposite electricities, and that, after
completing the circuit by means of the muscles and nerves,
an electric current, as in the case of the Leyden battery,
arises which convulses the legs of the frog.  Electricity
obtained in this manner, is called, electricity by contact,
galvanism or Volta's electricity.
Galvani's discovery, and more particularly Volta's, was
afterwards employed by physicians. The use of these apparatuses was at first complicated with a good many difficulties,
and the knowledge of the physicians was not sufficient to
draw from these new sources all the benefit they might have
yielded. Physicians, being unused to such new phenomena,
soon lost sight of them, and natural philosophers were the
only ones who continued to investigate and apply them. The
gradual elucidation of the phenomena of electricity and galvanism by means of the physical sciences is too well known
to require any detailed account of it in this place. Latterly
medical science again became intimately mixed up with the
natural sciences, and electricity and magnetism were again
resorted to for therapeutic purposes. The fact that soft iron,
when surrounded by copper wire, and sufficiently insulated, is
rendered.magnetic bypassing through it a current of electricity, led to the discovery of the electro-magnetic apparatuses
in which both forces are combined and act together. Clever
mechanicians simplified these apparatuses so as to render
them available for purposes of cure, and to induce physicians
to use them. Their expectations relative to the curative effects
of these apparatuses, were surpassed in every respect.
For a number of years I have instituted experiments with
20




298               ELECTRO-MAGNETISM.
electro-magnetism, both on men and animals, and I have
had abundant opportunities of verifying the extent of its
curative agency.  The results which I have obtained by
means of the method which I am in the habit of pursuing,
are so striking that I cannot forbear to give them to my
readers. Previously, however, I deem it advisable to offer a
few hints concerning the mode in which the electric principle
acts in the animal organism, even when excited by external
applications.
It is well known that at every contact of heterogeneous
substances, or while different parts of the body are exposed
to different degrees of temperature, or during all chemical
processes, the electricity of the body with which these various
processes take place, is excited into polar action; hence it is
undeniable that electricity plays an important part in the
living organism.  During the oxydation or carbonization of
the blood, during the process of digestion and so forth,
electricity exercises the most important part. It is certain
that many diseases, such as rheumatism, gout, etc., arise
simply from  the fact that the electrical condition of the
part had been rendered abnormal by the local depression of
the temperature of the affected part.
The Italian naturalist, Mateucci, has demonstrated the
existence of electricity in the living organism by numerous
experiments. According to his doctrine, however, it is not
the nerves but the muscles that are the vehicles of this
electric action. He asserts that the nervous principle is still
enveloped in much mystery and is entirely distinct from electricity.  Dubois Raymond, however, by his experiments
which are described in his work on animal electricity, has
refuted Mateucci in the most conclusive manner.  Dubois
Raymond proved by experiment that animal electricity is
contained in every part of the nervous system; he shows that
the nerves are capable of producing all the known phenomena
of electricity, even the deviation of the magnetic needle' by
means of a multiplicator.  He further shows that this electrical action is not simply an indifferent adjunct but an essen



ELECTRO-MAGNETISM.                  299
tial cause of the internal movements of the animal organism.
According to this observer the electrical action is identical
with the hypothetical nervous fluid.
Professor Hassenstein has likewise shown that during life
a portion of the natural electricity of the animal body is constantly excited into polar action.  According to him, the
central organs of the nerves are the immediate causes of this
action, and the nerves are its carriers and vehicles throughout
the whole organism.  The electric action which we see in the
muscles, is a consequence of that nervous action, and, therefore, depending upon the latter.
We infer from this incontestible fact that this electrical
action of the nerves must have a definite polar direction.
This point has likewise been demonstrated by Hassenstein
experimentally, and likewise that the polarity of this action
is unchangeable, whereas formerly it was supposed that it is
changeable.  This electrical action differs in different individuals, but it remains nearly the same during health in the
same person, and within a period of time of about the same
length.
The whole surface of the body is negatively electric; this
electricity is most feeble in those parts which are nearest to
the central organs, and most intense in parts which are most
remote from them.  This fact explains the character of the
polarity of the nervous electricity, and shows that the negative pole is directed towards the external, and the positive
pole towards the internal surfaces., In this respect the animal body has to be looked upon as a Voltaic pile, the surface
of the body constituting the negative, and the central organs
the positive pole of the pile.  In the same manner as the
action of these electricities which now attract and then again
repel each other, is kept up in the pile in a definite polar
direction, is the electrical action maintained in the central
nervous organs and in the nerves themselves as long as'life
lasts.  This action ceases after death; the electricities unite
and the central organs are no longer able to separate them.
From these preceding remarks we infer that only a portion




300               ELECTRO-MAGNETISM.
of the natural electricity of the organic body is in polar
action, and that another portion remains latent.  Some of
this latent electricity may, however, be excited into polar
action by external stimuli, and this polarity may be altered
ad libitum according as the negative pole is applied to the
peripheral nerves and the positive pole to the central organs,
or vice versa the negative pole to the central organs and the
positive pole to the peripheral nerves.
By applying the negative pole to the hand and the positive
pole to the spine, the ensuing electrical induction causes a
repulsion of the homogeneous and an attraction of the opposite electricities, and the polar direction of these attractions
and repulsions is the opposite of what it is in the original
bodies.  On the contrary, if the positive pole be applied to
the hand, and the negative pole to the back or the forehead,
the electricity which is set free, will have the same polarity
as the natural electricity. In the former case the electrical
action originally existing in the nerves is diminished, in the
latter case increased.  It is readily perceived that in whatever body a certain amount of electricity is excited into polar
action, its natural electrical action is increased when by some
adequate stimulus, a larger amount of its electricity is excited
into a corresponding polar action. On the contrary, if a
portion of the previously latent electricity is excited into a
polar action opposite to the polarity of the electricity which
is already active in the part, a larger or less portion of the
latter is necessarily neutralised, and the natural electricity
of the body is weakened.  Hence the object which we seek
to attain by acting upon the human body by means of electricity, can only be:
1. To exalt the action of the electricity which is already
active in the nerves, or
2. To diminish this action.
According to Hassenstein either of these ends may be
attained:
a. An increase of electric action, by applying electricity




ELECTRO-MAGNETISM.                  301
of the same polarity as that which is originally active in the
part.
b. A decrease of electric action, by applying electricity of
an opposite polarity to that which is originally active in the
nerves.
A physician is frequently called upon either to exalt or to
diminish the vital action, or to reduce it to its normal condition. In every disease, no matter what its cause, the normal
vital action, and of course the electric nervous action are disturbed, there is either an abnormal more or less.
In many diseases the metamorphosis of the tissues takes
place much more rapidly than in a state of health. We know
that, during every chemical process, and hence during the
metamorphosis of the tissues, electricity is set free the more
copiously the more energetically these chemical processes are
carried on; for it is probable that they are determined by
electrical action. If the metamorphosis be arrested, and the
chemical action consequently diminished, there is of course a
corresponding decrease of electric action in the nerves. This
shows how intimately the condition of the body in the various
diseases is connected with the electric action of the nerves,
and what an important agent electricity is in the treatment
of disease.
The curative action of both electricity and magnetism  is
increased by uniting both forces in one apparatus as is done
in electro-magnetic batteries.
We have now to state in what diseases electro-magnetism
is of particular benefit to patients. Numerous observations
instituted by ourselves and by other physicians, have abundantly shown that,
a. An increase of electric nervous action is required in
the following diseases: hypochondria and hysteria, anesthesia, general and local debility, weakness of the urinary and
sexual organs, impotence, retention and suppression of the
menses, weak stomach, constipation, weak eyes, hard hearing
and deafness, paralysis of any kind.




302.ELECTRO-MAGNETISM.
b. A decrease of nervous electric action, in the following
affections: rheumatic and arthritic pains, nervous headache,
rheumatic and nervous toothache, nervous pains in general,
hyperaesthesia, rheumatic swellings, podagra, white swelling
of the knee, spasmodic diseases of any kind, such as: cardialgia, spasm of the chest, prosopalgia, epilepsy, catalepsy, chorea, cephalalgia, excessive sexual excitement, nymphomania
and satyriasis, suppression of milk, vertigo, fever and ague,
profuse menstruation.
c. A local action of both electricities, when the nervous
action is neither to be increased or decreased, and it is simply
designed to excite the chemical electric action in certain
localities of the organism; as in the following affections:
glandular indurations, tumors, excrescences, ulcers, schirrus,
cancer, fungus hematodes, fungus medullaris, gangrene,
primary syphilis, strictures of the urethra, fistula, dimness
of the cornea, leucorrhoea, cataract.
My mode of using electro-magnetism is based upon the
doctrines of Hassenstein and Duchenne.  Having for years
devoted myself exclusively to the treatment of sexual diseases,
I have had frequent opportunities of employing Duchenne's
method of localised galvanization, together with Hassenstein's method.  According to Duchenne's method we are
enabled to electrify on the living body, the skin, muscles
and nerves, alone and isolated from the adjacent tissues; in
other words, to localise the curative effects of electricity,
and confine them to the skin, muscles and nerves, according
as the case may require.
If we simply wish to electrify the skin, and the terminal
extremities of the cutaneous nerves, we apply dry conductors
to the dry portions of skin that we wish to act upon. The
course of the nerves has to be exactly known for this purpose.
The electric action has likewise to be regulated, for it may
be increased from a mere prickling and tingling to an intense
pain.
These modifications are attained by means of the following
manipulations:




ELECTRO-MAGNETISM.                 303
a. With the electric hands.
b. With the electric conductors.
c. With metallic wires.
a. With the electric hand. One of the conductors is applied
to the sensitive part, for example, to the spinal column, the
other conductor is held by the operator in one hand, and
with the dry fingers of his other hand he makes passes over
the skin after it had first been dried.
This proceeding is resorted to in the case of very sensitive
patients who cannot bear the direct action of even the slightest
degree of electricity.
b. Localised galvanization by means of metallic conductors,
is effected by applying one of them to a part somewhat remote
from the affected region, and the other one dry to a part
adjoining the affected part.
c. Metallic wires are applied in the same manner as the
conductors, except that, in the place of one of the conductors,
a metallic brush or broom is used.
The electric brush represents the highest degree of localised
galvanism.  If it is moved about, or the skin is struck with
it, this proceeding is termed electrical flagellation; if the
brush is kept steadily at one spot, we term this the electrical
moxa.
If we desire to act upon a certain muscle without affecting
at the same time the superimposed tissues, Duchenne advises
to moisten all the tissues situated between the conductor and
the muscle in such a manner that the electrical current passes
rapidly through the moistened layers and reaches the muscle
without irritating the other layers. In this way the muscle
is alone excited into contractions.
The same process is resorted to if we wish to act upon
larger or smaller nervous trunks; but the course of the nerve
has to be exactly known.
We have not followed this method exclusively, but have
often combined it with Hassenstein's.  In applying this
method, whenever the electric nervous action had to be increased, as in hypochondria and hysteria, general debility




304                ELECTRO-MAGNETISM.
caused by onanism, involuntary emissions, sexual excesses,
we apply the negative pole to the back, occiput, and the
positive pole to the arms, legs, or abdomen.
In impotence we apply the negative pole to the occiput or
back, the positive pole to the perinaeum.
In local or general debility we apply the negative pole to
the back, the positive pole to the affected part.
In suppression or retention of the menses we apply the
negative pole to the lower portion of the back, in the lumbar
or sacral region, and the positive pole to the inner pudendum,
even to the uterus.
In paralysis the negative pole is applied to the back, the
positive pole to the paralysed part.
In diseases which require a diminution of electric action,
such as spasmodic diseases, we apply the negative pole to the
affected part, and the positive pole to the back.
In excessive sexual excitement, nymphomania, satyriasis,
we apply the negative pole to the hands, perinaeum, or abdomen, and the positive pole to the back or occiput.
In profuse menstruation the negative pole is applied to the
abdomen, or pubes, and the positive pole to the sacral region.
The apparatuses which I use with the best effect are those
of Neef, with modifications and corrections by Steinberger,
according to my own indications; they are provided with a
scale by means of which the increase or decrease of the
electric action can be exactly regulated. The pocket apparatuses constructed by this maker, are particularly commendable
both for their neatness and their correctness.




INDEX.
PAGE
Alopecia syphilitica,......................................... 140
Arthritis blennorrhoica,...................................................   80
Balanitis,..................................................                                      56
Balannorrheia,......................................................   56
Balanoposthitis,.........................................................................   56
Bladder,.................................................................................. 11
Bladder, catarrh   of  the,.............................................................  279
"       blennorrhoea  of the,..................................................... 279
" hypertrophy  of the,........................................... 283
"       inflammation  of the.......................................................  68
"       spasm   of the,......................................................                              85
Bone-pains, syphilitic,..................................................... 157
Buboes,....................................................................................  113
Buboes, gonorrhoeal,..................................................................   66
Bulle,..................................................................................... 132
Cachexia syphilitica,......................1............................ 174
Calculi, urinary,................................................  273
Caries  syhilitica.......................................................................  163
Catarrh  of the bladder,..........................................   279
Chancre,............................................... 108
Chordee,................................................................................   61
Circocele,................................................................. 188
Condylomata,............................................................................  180
Condylomata syphilitica..........................................................   137
Cystitis...................................................................................                       68
Disorganisations,  gonorrhoeal..............................................              81




306                                                          INDEX.
PAGE
Dolores   osteocopi,.....................................................................  157
Dysuria,..............6.........................................              62
Eczema,...........................................................................              63
Electro-magnetism,....................................................................  296
Emissions,  seminal,.......................................................  218
Ephelides,.............................................................................   129
Epididymitis  blennorrhagica........................................................    68
Erections.................................................................................    60
Erythemata,  syphilitic.................................................  122
Exanthems,  syphilitic................................................................  127
Excesses,  sexual.......................................................................  197
Exostosis,..............................................................................  161
Eyes, tertiary  affections  of the1,.......................................                                                  170
Fecundation,.............................................................................    34
Fibrous and  parenchymatous organs, affections of........................... 149
Figwarts,.............................................................................                                           137
Fluor  albus,.............................................................................    96
Glans, inflammation   of...............................................................                                            56
Gonitis  gonorrhoica,.................................................................    80
Gonocele,..................................................................................    80
Gonorrhoea  of the  buccal and  nasal cavities,....................................    78
Gonorrhoea  of the  female,............................................................    96
Gonorrhoea  of  males..................................................................    47
Gonorrhoea and blennorrhoea, affections which accompany,.................  60
Gonorrhoea of the rectum,....................................................  79
Gonorrhoea, sequele  of..............................................................    66
ravel,....................................................................................  273
Gummata  syphilitica,.................................................................  146
Hoematuria,...............................................................................  270
Haemorrhage  from   urethra,....................................................    61
Hair  and  nails, syphilitic  affections of the,.......................................  140
Herpes  praeputialis,................6.......................................                  63
Hydrocele,..............................................................................  185
Hypertrophy  of  bladder.............................................................  283
Impotence  of  the  male...........................................................  236
Incontinence  of urine,............................................................                                             268
Induration  of  the  coi'pora  cavernosa............................................  155
Inflammation  of  the  bladder,..........................................                                                         68




INDEX.                                                                307
PAGE
Inflammation  of Cowper's  glands.................................................    62
Inflammation   of  the  epididymis,.................................................    68
Inflammation'of  glans,...............................................................    56
Inflammation   of the  knee, gonorrhoeal,...........................................                                                    80
Inflammation of the prostate gland................................................   62
Inflammation  of the  urethra,.......................................................                                                 98
Inflammation   of  the  uterus,.....................................................  101
Inflammation   of  the  vagina,........................................................   100
Inflammation   of the  vulva,....................................................    99
Iritis   syphilitica,......................................................................  142
Itching   of the  glans,...................................................................    63
Kidneys,..................................................................................       9
Leucorrhea......................................................    96
Lichen,             d................................................................  131
Lithiasis,..............2.........................................        277
Macule....................................................................................  129
Menstrual derangements,............................................................  191
Metastatic  affections of gonorrhea,................................................ 66
Muscles and  tendons, tertiary affections  of the,.............................. 167
Necrosis  syphilitica,.................................................................  163
Nerves, tertiary  affections  of  the..................................................   172
Nymphomania,........................................................................    216
Oedema   preputii,.....................................I...........................        64
Onychia   syphilitica,................................................................         140
Ophthalmia   gonorrhceica,............................................................   174
Orchitis   syphilitica,                        1....................................................  149
Ovum......................................................................................    36
Papulee,.....................................................................  131
Paraphymosis,............................................................................  65
Parenchymatous organs, tertiary affections of,.......................... 174
Periosteum and bones, tertiary affections of the,...~................... 157
Periostitis  syphilitica,.................................................................   160
Phymosis,........................................................                                               64
Plaques   muqueuses...................................................................  124
Priapism...............................................................................  60
Prostate  gland, inflammation  of the............................................    62
Prostate gland, chronic inflammation and suppuration of,..................  81
Prostatitis,...............................................................................                                             62




308                                               INDEX.
PAGE
Pruritus glandis,.............................................................   63
Pustules,  syphilitic,................................................................... 132
Retention  of urine,.........................................................2.........   258
Rupia syhilitica,....................................................................... 135
Sacocele  syphilitica,................................................................... 149
Satyriasis,.........................................................60, 214
Scales, syphilitic....................................................................     131
Self-abuse.......................................................................... 196, 202
Semen,........................................................................   35
Sexual functions, physiology of the,..............................................   33
Sexual organs, male.......................................................... 20-26
"        "       female....................................................                      26-33
Sexual organs, non-syphilitic, diseases of the.................................  185
Spasm  of the bladder...........................................................       285
Spermatorrhea........................................................................ 218
Spinal diseases...................25..................3........................       253
Spinal irritation......2............................................... 253
Spots,............................................................................... 129
Sterility  of the female,............................................................... 244
Stone,..,............................... 277
Strictures  of the  urethra...........................................................   84
"        Cauterisation  of,......................................................   94
"        Dilatation of..............................................................   90
"        Scarifications  of.........................................................   95
Subcutaneous and submucous tissue, tertiary  affections of the,........... 146
Swelling  of the prepuce,.......................................................   64
Syphilis, constitutional............................................................... 118
Syphilis, history  of......................................................   42
Syphilis of little children,.............................................. 180
Syphilis, primary...................................................................... 107
Syphilis,  secondary................................................................... 121
Syphilis, squamous,............................................    131
Syphilis, tertiary.....................................................................  145
Syphilisation,........................................................................... 287
Syphilitic diseases of the mucous membranes.................................. 122
Tabes dorsalis.......................................................................... 256
Tubercles,  cutaneous......................................................                              130
Tubercles, mucous,................................................................... 124




INDEX.                                                                309
PAGE
Tubercles  of mucous  membranes, deep-seated.................................  126
Ureters,...................................................................................                                              i1
Urethra,....................................................................................    12
Urethritis...............................................................................                                               98
Urging   to  urinate,.....................................................................  265
Urinary and sexual organs, description of the,.................................    9
Urinary  and   sexual  organs, diseases  of the,...................................    42
Urine,......................................................................................    14
" physical properties  of the,...................................          17
Urine,   bloody,..........................................................................  270
Urine, retention  of,.................................................................... 258
Uteritis,...................................................................................  101
Vaginitis,...................................................................................  100
Varicocele,...................................................................  188
Venereal   diseases,  simple..........................................................   47
Vesicles,  syphilitic,.........................1................................          132
ulvitis,..................................................................................    99