blisters not completly developed, do the old itch pustules partially remain or re-appear. From the fifth to the sixth day, the inflammation, redness, and burning of the skin diminish, and the skin peels in such large masses, that parts of the body an inch broad and long become visible, covered with quite new and perfectly clean epidermis. The sleep is quiet and the patient feels himself comfortable. In the bath the cuticle comes off completely; the new skin is free from eruption and what still remains of the old skin is already destroyed and peels off the next day without further assistance. GRAF continues rubbing the skin with tallow made fluid every evening, for eight days, for the purpose of removing the tension which sometimes continues in the delicate young skin and to facilitate the scaling of still firmly attached old pieces of epidermis. In eruptions of many years standing, he first orders a purifying medicine of tartar emetic and sulphate of soda; and during the rubbing gives internally two doses of sulphur daily, and rubs in a day or two longer. In cases where, after some years, the itch still remains local, the soap alone is sufficient; but when the above-described general symptoms are present, suitable internal remedies must be employed. In seven days GRAF (a) cured an elephantiasis spreading over the whole body. For the reasons above described the efficiency of this mode of treatment may be judged of, and to it may be added some methods which have recently been recommended as especially efficient." VÉZIN's treatment, a lukewarm bath, in which the patient, standing, is to be rubbed over the whole body with warm water and black soap by means of a piece of coarse woollen stuff, with which care should be taken to rub off the existing itch-pustules and blisters. The patient is then, without further clothing, to be covered up in thick flannel and lie for twelve hours on a mattress provided with a pillow, and covered up, besides the cloak, with a woollen cloth. After the lapse of the appointed time he gives up his cloak and lying down, for the purpose of rubbing in, near the fire, a sufficient quantity of the following salve, sulph. depur. subtillissime pulv. 3 j. rad. helleb. alb. subl. pulv. 3ij. potass. nitr. subl. pulv. gr. x. sapon. nigr. 3j. adip. suill. 3iij. M., over the whole body and especially on those parts affected with the eruption, after which he puts on his cloak and resumes his former position. After twelve hours, this rubbing is to be repeated, and again after another twelve hours. When the fourth twelve hours have passed, the second and last bath is to be used, in which he remains as long as in the first; and the cure is completed. During the cure care must be taken that the temperature of the sick-chamber should be kept up to 28°-30° RÉAUMUR [=95° to 100° FAHR.] The patient should then put on clean linen and his previously disinfected clothes. PENTZLIN (b) uses tar soap, composed of one part of good fat tar, two parts of old salt butter melted together over a charcoal fire, and one part of finely powdered potash shaken into it whilst being stirred; this the patient with the help of an assistant rubs over the whole body without overlooking a spot. After putting on a clean shirt the patient goes to bed and there continues at the second rubbing, which is to be done twenty-four hours after in a similar manner. After the first or second rubbing, the single pustules are observed to shrivel and form a flat smooth crust. Neither irritation nor inflammation of the skin is observed; the patient, however, complains of a disagreeable sensation principally depending on the somewhat sticky nature of the ointAfter the fourth, and at latest after the seventh rubbing all the pustules are seen to be changed into thin, smooth, brownish crusts; the rest of the skin appears smooth and natural. The patient must, however, have a purifying bath of 28° RÉAUMUR [=95' FAHR.], and after remaining in it some time and careful rubbing, the whole body is, ou leaving the bath, to be properly rubbed with green soap, and he is put to bed, where, by careful rubbing kept up with woollen cloths, everything attached to the skin is removed (c). [In the Belgian army liquid sulphuret of lime is used for the cure of the itch according to the following order:-"Each patient is to be supplied with an ounce or an ounce and a half of liquid sulphuret of lime in a small pot. This quantity he is to rub carefully and slowly with his hands on every part that is covered with papula. If there be any papula on the back, another patient is to rub the liquid on that part. The operation is to be repeated three times in the twenty-four hours so that each patient consumes three or four ounces of the sulphuret daily. A bath is to be taken every alternate day; the frictions are to be suspended on that day. Fifteen frictions (or ten ment. Above cited. (b) Above cited. (c) Dr. SERGER, Vergleichende Versuche über die Behandlungsarten der Krätze nach VEZIN, FRICKE, und PFEUFFER; in Würtemb. Correspondenzblatt, 2839, July 29. days' use) are usually sufficient for the cure of the disease, if the medical officer in charge sees that the remedy is properly used. Preparation of the sulphuret of lime.— Take of sublimed sulphur 16 lbs. and of quick lime 32 lbs. and boil in 80 lbs. of water for three quarters of an hour. Let the mixture rest for some time until it settle, and then let the clear fluid be decanted off. Boil the residue afresh in about the same quantity of water, treat it in a similar manner, and add this decoction to the first. Usually 140 lbs. of the sulphuret, at 12° by the areometer are thus obtained. If the liquid be more dense, it should be lowered to this standard by the addition of rain water (a).] If the 811. In Complicated Itch the local treatment must be preceded by, or accompanied with the internal remedies in part already mentioned, sulphur alone, or with antimony, purgatives, woody drinks, and the like. itch by its long continuance have very much weakened the patient, or if a scrofulous, syphilitic, scorbutic, gouty, or rheumatic dyscrasy exist, the proper remedies for them must be employed. 812. Itch ulcers may be bathed with sublimate water, aqua phagedenica, in addition to sulphur ointment, or any of the above-mentioned salves. If these ulcers be of long continuance, it is advisable to establish issues before stopping them up, which in a very old itch is especially not to be neglected. 813. If the itch be quickly suppressed, we must endeavour to restore the eruption by blisters, by rubbing of tartar emetic ointment, washing and rubbing the skin with irritating remedies, and even by inoculating the itch; at the same time also external remedies acting on the skin, especially sulphur and antimony, must be used. VI.-OF VENEREAL ULCERS. ASTRUC, J., De morbis venereis libri novem. Edit. Nov. Venet., 1760. 2 vols. 4to. London, 1786. 4to. FABRE, Traité des Maladies Vénériennes. Third Edit., 1773. 8vo. 1803. 3 vols. 8vo. FLECKER'S, A. F., Deutliche Anweisung, die venerischen Krankheiten genau zu erkennen und richtig zu unterscheiden. Second Edit. Erfurt, 1801. 8vo. CLOSSIUS, K. F., Ueber die Lustseuche. Second improved Edit. Tubing., 1799. 8vo. SWEDIAUR, F., Traité complet sur les symptômes, les effets, la nature, et le traitement des Maladies Syphilitiques. 2 vols. Seventh Edit. Paris, 1817. 8vo. LAGNEAU, L. F., Exposé des Symptômes de la Maladie Vénérienne. Third Edit Paris, 1812. 8vo. LOUVRIER'S, J., Nosographisch-therapeutische Dartsellung syphilitischer Krankheitsformen. Nebst Angabe einer zweckmässigen und sicheren Methode, veraltete Lustseuchenübel zu heben. Second improved Edit. Wien und Krems, 1819. 8vo. WENDT, J., Die Lustseuche in allen ihren Richtungen und in allen ihren Gestalten. Third Edit. Bresl., 1825. 8vo. RITTER, G. H., Darstellung der scheinbaren Aehnlichkeit und wesentlichen Verschiedenheit, welche zwischen der Schanker und Tripperseuche wahrgenommen wird; 35 jähriger Beobachtungen und Erfahrungen mit Bemerk. über die wichtigsten Punckte der venerischen Krankheiten. Leipzig, 1819. 8vo. CARMICHAEL, R., M.D., An Essay on Venereal Diseases, and the uses and abuses of Mercury in their Treatment. Second Edit. London, 1825. 8vo. IB., R., M.D., On the Symptoms and Specific Distinctions of Venereal Diseases. London, 1818. 8vo. (a) BRAITHWAITE's Retrospect of Practical Medicine and Surgery, vol. x. p. 115. DELPECH, Considérations sur les Maladies Vénériennes; in Chirurgie Clinique dé Montpellier, Paris et Montpellier, 1823, 4to., p. 263. DEVERGIE, N., Clinique de la Maladie Syphilitique, avec un Atlas colorié, etc. Paris, 1826. 4to. BACOT, JOHN, A Treatise on Syphilis, in which the history, symptoms, and method of treating every form of that disease are fully considered. London, 1829. 8vo. LAWRENCE, WILLIAM, Lectures on Surgery, in Lancet, 1829-30, vol. i. TRAVERS, BENJAMIN, Observations on the Pathology of Venereal Affections. London, 1830. 8vo. HACKER, H. A., Literatur der syphilitischen Krankheiten vorn Jahr 1794 vis 1829. Leipzig, 1830. WALLACE, WILLIAM, A Treatise on the Venereal Disease and its varieties. London, 1833. 8vo. BONORDEN, H. F., Die Syphilis, pathologisch, diagnostisch und therapeutisch dargestellt. Berlin, 1834. COLLES, ABRAHAM, Practical Observations on, the Venereal Disease, and on the use of Mercury. London, 1837. 8vo. DESRUELLES, Traité pratique des Maladies Vénériennes. Paris, 1836. BOTTEX, De la Nature et du Traitement de la Syphilis. Paris, 1836. BOYER, Traité pratique de la Syphilis. Paris, 1836. CHAMPIONNIÈRE, L., Recherches pratiques sur la Thérapeutique de la Syphilis, ouvrage fondé sur les observations recueillées dans le service et sur les yeux de M. CUIL LERIER. Paris, 1836. GIRAUDEAU DE SAINT-GERVAIS, Traité des Maladies Syphilitiques. Paris, 1838. RICORD, Traité pratique des Maladies Vénériennes, &c. Paris, 1838. 8vo., and translated into English by H. P. DRUMMOND, M.D. London, 1842. 8vo. 814. Venereal Ulcers, Chancres, (Ulcera Venerea, Syphilitica, Lat. ; Schanker, Germ.; Chancres, Fr.,) are distinguished as primary and secondary (1); the former are consequent on the inoculation of venereal poison and occur at the place of infection; the latter are symptoms of general infection of the body (2). [(1) The terms venereal ulcers, chancres, here used indiscriminately by CHELIUS in reference to both primary and secondary sores, are incorrect. All the sores which result from impure connexion are venereal, in the common acceptation, but all venereal sores are not chancres; therefore to name them chancres produces an erroneous impression of their nature, and should be avoided. The employment of the title, chancre, to sores whether primary or secondary is also improper, for although the primary sore, to which alone English Surgeons, following the authority of JOHN HUNTER restrict the name, chancre, may infect the constitution and cause secondary sores and other symptoms, which, together, are by him designated lues venerea, yet the matter from a secondary sore will not produce chancre, as proved by HUNTER's experiment of inoculating a man who had venereal blotches with matter from his own sores, and also with chancrous matter, in which case the former wounds healed up, but the latter became chancres. It is therefore preferable to give the name syphilis to the whole series of symptoms resulting from the communication of the poison of the Hunterian chancre, which is the primary manifestation of the disease, as the ulcers in the throat, the eruptions and sores on the skin, and affections of the bones are the secondary or constitutional results. (2) JOHN HUNTER says:-"The venereal poison is capable of affecting the human body in two different ways; locally, that is in those parts only to which it is first applied and constitutionally, that is in consequence of the absorption of the venereal pus which affects parts while diffused in the circulation. *** The local or first kind is what I have called immediate, arising immediately upon the application of venereal pus. Of this kind there are two sorts seemingly different from one another. In the first there is a formation of matter without a breach in the solids, called a gonorrhea. In the second there is a breach in the solids called a chancre. Neither of these two ways in VOL. I. 2 T which the disease shows itself is owing to anything peculiar in the kind of poison applied, but to the difference in the parts contaminated." (p. 24.) "The most important feature in the natural history of syphilis is," says LAWRENCE, "the progress of the complaint from one part of the body to another; the succession of symptoms it shows in successive organs and textures; the frequent renewal of the disease in the same organs, or textures, after it has apparently ceased. Some forms of the disease are attended with considerable suffering, great local suffering and considerable constitutional disturbance. When we find that these symptoms are capable of showing themselves, from time to time, in different parts; when we find the disease come on again and again in the same part; when we find that those affections require, as they frequently do, the employment of vigorous and active means of treatment, which exert powerful influences on the animal economy, we cannot wonder that the constitution is frequently enfeebled by the disease, and that in some cases, patients ultimately sink under it. In this point of view, the nature of syphilis is sufficiently serious, though not so serious as formerly supposed.” (p. 723–24.)] 815. The operation of the venereal contagion pre-supposes a peculiar delicate structure of the part or a deprivation of its cuticle. Primary syphilitic sores therefore usually arise on the glans, and on the prepuce, on the buttocks, on the nipples, on the lips and tongue, according as the infection has occurred from connexion, from suckling children, from kissing, and the like. 816. From two to four days, sometimes longer, sometimes shorter (1), after the communication of the venereal poison in an impure connexion, there appears on some part of the glans or prepuce in men, and on the labia or nymphæ in women, a red inflamed spot, accompanied with a smarting sensation, and usually in men with frequent erection; this rises to a little vesicle filled with pale fluid, which after sometime breaks and leaves behind a superficial excoriation; or a hard painful lump arises, which bursting forms a painful ulcer. These ulcerated spots enlarge, have more or less hard everted edges, surrounded with an inflamed edge, and having a foul lardaceous bottom; or they are often covered with scurf, are often very eating, or have everted but not hard edges. They spread more quickly or more slowly in breadth and depth, are more or less painful and inflamed, become sometimes even sloughy, cause considerable destruction, and often even bleeding (2). The pus secreted by venereal ulcers, is sometimes thin, sometimes of more consistent nature, of a yellowish-white or yellowish-green colour, and makes on white linen, spots like half-melted tallow. Its quantity is always more considerable than from the size of the ulcer might be expected. After healing, scars remain, which have the same size as the previous ulcers. [(1) JOHN HUNTER says:-" I have known cases where the chancres have appeared wenty-four hours after the application of the matter, and I have known them seven weeks.*** An officer in the army had a chancre break out upon him two months after he had had any connexion with a woman." (p. 232.) RICORD, in addition to this, observes that "experience has shown him that on the third day of inoculation the pus of chancre became contagious and sometimes even on the second." (p. 540.) (2) "This like most other inflammations which terminate in ulcers, begins, says JOHN HUNTER," first with an itching in the part; if it is the glans that is inflamed. generally a small pimple appears full of matter, without much hardness, or seeming inflammation, and with very little tumefaction, the glans not being so readily tumified from inflammation as many parts are, especially the prepuce; nor are the chancres attended with so much pain or inconvenience as those on the prepuce; but if upon the frænum, and more especially the prepuce, an inflammation more considerable than the former soon follows, or at least the effects of the inflammation are more extensive and visible. Those parts being composed of very loose cellular membrane, afford a ready passage for the extravasated juices; continued sympathy also more readily takes place in them. The itching is gradually changed to pain; the surface of the prepuce is in some cases excoriated, and afterwards ulcerates; in others a small pimple or abscess appears, as on the glans, which forms an ulcer. A thickening of the part comes on, which at first and while of the true venereal kind, is very circumscribed, not diffusing itself gradually and imperceptibly into the surrounding parts but terminating rather abruptly. Its base is hard and the edges a little prominent. When it begins on the frænum or near it, that part is very commonly wholly destroyed, or a hole is often ulcerated through it. *** The original excoriation or wound may heal although contaminated, and afterwards become a chancre. (p. 233.) * LAWRENCE observes, that" generally speaking, the process of ulceration in a syphilitic sore is not very rapid; it is rather a chronic kind of ulceration, though there is considerable difference in the various kinds of sores, which belong to this disease. Usually speaking, the syphilitic sore is of a circular figure, but not necessarily so. The sores which are produced by the application of venereal poison to the external organs of generation are various in their appearance. We cannot describe one particular character of sore, as the result of venereal poison. We find that there are several, all of them seeming to be equally produced by that cause, and yet differing materially from each other in their characters." He divides these sores into five kinds: 1st, the simple venereal sore, (venerea vulgaris of EVANS,) a superficial ulceration, taking place very commonly on the internal surface of the prepuce. Usually there is more than one; generally a sore upon the corona glandis, frequently two, three, or four of them, in that situation just behind the prepuce; or such a number may form around the orifice of the prepuce itself. In the first place there is a degree of excoriation from ulcerative absorption; after a certain time the excoriation thus produced is filled up, so that the sore becomes again level with the rest of the surface, the continuation of the reproductive process goes on, and produces an excess of substance in that particular part, so that it projects above the surrounding surface and then the part cicatrizes. These are the stages this sore goes through, and it will often occupy four, five or six weeks in proceeding through the different stages. It is also very painful, and commonly the surface bleeds when the dressings are changed and the part is exposed. *** 2nd, A venereal sore in which the margin of the ulceration is elevated, and a little indurated; * there is a roundish kind of margin; the surface of the sore itself has something in it of a peculiar character, and the discharge from it is scanty in quantity; it bursts and forms a thin scab. 3rd, The indurated chancre, that is, a venereal ulceration taking place on an indurated basis, so that the margins of the sore and the basis on which it is formed present an unnatural hardness." This is HUNTER'S chancre, but LAWRENCE does not agree with his views in reference to the hardened base and edges being essential to the character of a true syphilitic sore. "4th, The phagadenic primary sore, presenting the removal of a part by ulcerative absorption; the part has a sharp edge, is sometimes undermined, and the surface is irregular and ragged; there is an eating away, as the term implies, of the textures of the part; there is no formation of granulations; there is nothing like an attempt at the reproductive process, and there is a thin ichorous and very offensive discharge from the sore. Sometimes this phagedenic ulceration extends slowly on the prepuce or glans, and greatly destroying those parts; at other times it goes on with much more rapidity; the surface of the sore assumes a livid appearance; there is an ichorous discharge; the ulcerative process goes on, and it frequently destroys the whole of the organ. 5th, The sloughing or gangrenous chancre, where there is a loss of vitality, and the surface of the sore assumes a dark, black, and manifestly a sloughy appearance. The surrounding parts are highly inflamed in this case; there is considerable redness, swelling, and acute pain; there is also loss of vitality, and the ulcerative surface of the part that has sloughed is separated, and a fresh slough forms over the part; thus the sore becomes rapidly larger and it spreads in every direction, until the part is destroyed by that kind of process constituting sloughing phagedena. ***This sloughing change is found to take place under two different circumstances. We very commonly see it as the result of neglect and intemperance, in the cases of sores that may not have been sloughy originally, and where persons having primary syphilitic sores take none of the precautions to get rid of them, but continue their occupations and go on with their intemperate habits, causing a high degree of inflammation to be superinduced upon a complaint which is of itself originally of an inflammatory nature; but in other cases the sloughy state is observed from the very first; there is a high degree of constitutional disturbance under this form of change; there is a full and hard pulse, more particularly when it occurs in young robust persons; a white tongue, and in fact the general symptoms that characterize high inflammatory fever." (p. 765-66.)] |