28 



MEDICINE. 



Prctic. of the treatment. To these tonics and stimulants may 

 >-^y. be occasionally added ; but we do not conceive that any 

 great benefit "i to be derived from them, unless where 

 theappetite is particularly defective, and when the bowels 

 are brought into a natural state. Still less confidence 

 do we place in any of those remedies, which have been 

 from time to time offered to our notice, as possessing a 

 specific effect in Rickets, such as phosphate of lime, upon 

 the principle of supplying the deficiency of this sub- 

 stance in the bones, or the carbonate of ammonia, for 

 neutralizing the supposed acid in the blood, remedies 

 which we believe will be found as useless in practice as 

 we apprehend them to be incorrect in theory. It is a 

 difficult point to determine upon the means that ought 

 to be adopted for counteracting the mechanical defor- 

 mity that arises from the state of the bones. Perfect 

 rest in the horizontal posture has been recommended; 

 but in very young children this is almost impossible to be 

 strictly adhered to, while the want of exercise is itself 

 a means of increasing the tendency to disease ; nor in- 

 deed does it appear, that, with all our care, we are able 

 to prevent the bones from being distorted by the action 

 of the muscles that are attached to them, or by the 

 weight of the different parts pressing upon each other. 

 Upon the whole, it may be desirable to recommend the 

 horizontal in preference to the erect posture during a 

 part of the day ; but we should not sacrifice to this sys- 

 tem, the benefit that may be supposed to arise from the 

 general salutary influence of air and exercise. It ap- 

 pears to be agreed, that the mechanical contrivances 

 for supporting or straightening the limbs are not of 

 much use in Rickets. 



SECT. VII. Syphilis. 



Syphilis. The treatment of this disease is considered as rather 

 falling under the province of the surgeon than of the 

 physician, yet it offers so many curious subjects for spe- 

 culation, and involves so many interesting questions of 

 pathology, that we cannot pass it by in our system, al- 

 though exclusively appropriated to the practice of me- 

 dicine. Notwithstanding Syphilis is a disease of the 

 most frequent occurrence, and one that has engaged 

 the attention of medical men for some centuries, there 

 are many very important points respecting it which still 

 remain undecided. The first accounts that we have of 

 the unequivocal symptoms of Syphilis appeared about 

 the end of the 15th century ; but how it was produced, 

 or from what quarter of the world it proceeded, are not 

 yet correctly ascertained. The disease, in its ordinary 

 form, is communicated by the actual contact of parts 

 previously infected, which necessarily happens most 

 frequently to the generative organs, and, independent- 

 ly of their situation, it is probable that their structure, 

 as possessing a surface covered by a thin cuticle, and 

 furnished with secreting glands, is peculiarly liable to 

 receive the infection. The first symptom is a local ul- 

 cer, to which the name of chancre has been applied, 

 and which seems to be altogether a local affection ; but 

 it is a property of the chancre to generate contagious 

 matter, which is capable of being absorbed, and of con- 

 taminating the system at large. Besides the local sy- 

 philitic ulcer or chancre, there is another form of vene- 

 real infection, in which, without any wound or breach 

 of the cuticle, a raucous, or secreting surface, becomes 

 inflamed, and exudes a large quantity of semi-purulent 

 matter, which has the property of inducing the same 

 state on a similar mucous surface with which it is in 



contact ; to this the name of Gonorrhoea has been ap- Practice. 

 plied. It has been a much disputed question, in what S * P Y**' 

 manner these two affections are related to each other, 

 whether they are distinct diseases, or whether they ori- 

 ginate from the same poison having experienced some 

 modifications, or assume a different aspect from the dif- 

 ferent nature of the parts to which it is applied. Upon 

 the whole, perhaps the most decisive facts are in favour 

 of the diversity of the two diseases ; but, at the same 

 time, we must remark, that some authors of the first 

 eminence profess the contrary opinion. It would be 

 inconsistent with the brief and general view which we 

 profess to take of the subject, to detail all the symptoms 

 of this proteiform disease, which, as it affects a great 

 variety of parts and structures, and attacks indiscrimi- 

 nately all constitutions and temperaments, exhibits a 

 greater diversity of appearances than perhaps any other 

 complaint to which the human frame is obnoxious. If 

 the local ulcer be not cured by the appropriate remedies, 

 and if means be not taken to prevent the contamination 

 of the system, a portion of the infectious matter is taken 

 up by the lymphatics, and seems to be carried into the 

 mass of I he circulating fluids. In its passage along 

 these vessels it usually affects some of the glands, pro- 

 ducing in them tumours, which are styled buboes, and 

 afterwards abscesses, which partake of the same infec- 

 tious nature with the original chancre, and still farther 

 contribute to the general diffusion of the disease. When 

 the system becomes in this manner completely contami- 

 nated, there are certain parts of the body which are pe- 

 culiarly disposed to manifest the presence of the poi- 

 son, and in these it exhibits itself in a uniform order of 

 succession. It first appears in the mucous membrane 

 of the throat and fauces, producing an inflammation and 

 superficial ulceration, which terminates in an erosion 

 and loss of substance, so as materially to injure the 

 form and organization of the part. About the same 

 time, various portions of the skin begin to exhibit the 

 effects of the disease ; brown or copper-coloured spots 

 make their appearance, from which a quantity of mat- 

 ter exudes, which concretes into a scurf. This, when 

 it falls off, is succeeded by another scurf, and so on un- 

 til at length ulceration is established. The next set of 

 symptoms, or the next order of parts that is infected, 

 is the periosteum, and the various appendages of the 

 bones ; these become thickened, and at length give rise 

 to painful tumours, called nodes, until the structure of 

 the bones themselves is finally disorganized. There are 

 certain bones which seem peculiarly disposed to suffer 

 by the syphilitic poison, especially the small bones of 

 the palate and the nose ; and when the disease has got 

 firm hold of the constitution, they are entirely corroded, 

 so as to cause a great defect in the speech, and the most 

 dreadful deformity of the countenance. Along with 

 these symptoms, which are all more or less of a local 

 nature, although depending upon the general diffusion 

 of the poison, the powers of the constitution begin to 

 suffer, the appetite fails, emaciation and loss of strength 

 ensue, hectic supervenes, and the disease terminates fa- 

 tally. These symptoms are usually recognized as the 

 effects of chancre, and it has been a much disputed 

 point, whether a similar train of complaints can be in- 

 duced by the poison of gonorrhosa, 1'his we are dis- 

 posed to decide in the negative ; but we do so, as in the 

 former case, in opposition to the judgment of many 

 persons, who are the best able to decide upon the sub- 

 ject. Whatever opinion, however, we may form re- 

 specting the contamination of the system by the matter 



