LUES VENEREA. 



Seventhly ; mercury does not deftroy a difpofition already 

 formed. 



Eiglitlily ; mercury hinders the aftion from taking place, 

 although the difpofition be formed. 



Ninthly ; mercury cures the aftion. 



Secondary Vemreal Ulcers. — Thefe are of a very different 

 nature from chancres, or fucli fores as originate direftly 

 from the application of venereal matter to the (kin. They 

 are generally much lets p:iinful than the latter, attended 

 with lefs inflammation, and do not fecrete matter, that can 

 communicate the difeafe to others, or caufe buboes in the 

 patient himfelf. They are more readily formed on mucous 

 membranes, than on the common integuments, and there- 

 fore are very frequent on the tonfils, and other parts of the 

 throat. Sores of this defcript:on arc often of a round (liape, 

 though, in certain examples, they eat away the parts, like 

 herpetic or phagedenic ulcers, fprcading from one part to 

 another, deftroying the (kin, and licaling on one fide, while 

 they are extending themfclves on another. Riclieraud has 

 feen ulcers of this kind, fpread in this manner nearly all 

 over the patient's body, producing one vail cicatrix ; and 

 he adverts to a particular fpecies of fccondary venereal ulcer, 

 which is of a round fhape, and begins to heal at its centre, 

 fo that towards the termination of the complaint the lore 

 reprefents an ulcerated circle, encompafling a round cicatrix. 

 When this variety of the difeafe makes progrefs, the ulcer- 

 ated ring becomes larger, while the cicatrix in the centre 

 undergoes a proportional increafe in fize. (Nof. Chirurg. 

 tom. i. p. 331, 332. edit. 2.) It may be doubted whether 

 the latter cafes are really fyphilitic : they certainly yield to 

 many remedies befides mercury, as our own obfervation 

 has convinced us. They may be cured by guaiacum, nitric 

 acid, a decottion of iarfaparilla, and elm bark, &c. 



Vinereal Eruptions. — On this fubjeft Mr. Hunter has 

 pointed out to us the following circunillances. 



The appearances on the ilvin generally occur all over the 

 body. The difcolourations make the flcin appear mottled, 

 and many of the eruptions difappear, while others continue, 

 and increafe with the difeafe. 



In other cafes, the eruption comes on in diftin6l blotches, 

 which are often not obferved till the fcurfs have begun to 

 form. At other times, the eruption afTumes the appearance 

 of fmall diftinft inflammations, containing matter, and re- 

 fembling pimples, not being, however, fo pyramidtil, nor 

 fo red at the bafe. Mr. Hunter alfo obferves, that venereal 

 blotches, on their firit coming out, are often attended with 

 inflammation, which gives them a degree of tranfparency, 

 which is generally greater in . the fummer than the winter, 

 efpecially if the patient be kept warm. In a little time this 

 inflammation difappears, and the cuticle peels off in the form 

 of a fcurf. Tlifi lattec-pccurrence often mifleads the patient 

 and the furgeon, who look upon this dying away of the in- 

 flammation as a decay of the difeafe, till a fucceffion of 

 fcurfs undeceives them. Mr. Hunter adds, that the difco- 

 lourations of the cuticle arife from the venereal irritation, and 

 are to be feldom regarded as a true inflammation, finte they 

 rarely have any of its charatleriftics, fuch as tumefaction 

 >iandpain. Hdwever, he explains that in parts which arc 

 well covered, or which arc conftantly in contadt with other 

 parts, there is more of the true inflammatory appearance, 

 efpecially about the anus. 



The parts affefted next begin to alter their appearance, 

 and form a copper-coloured, dry, inelaftic, cuticle, called a 

 fcurf. This is thrown ofi^, and new ones are formed. Mr. 

 Hunter relates, that thcfe appearances fpread to the breadth 

 of a fixpence, or Ihilliag ; but feldom more-extenfively, at 



leaft for a confidcrable time. In the mean while, every 

 fucceeding fcurf becomes thicker and thicker, till at lall it 

 becomes a common fcab. Then the difpofition for the 

 formation of matter takes place iu the cutis underneath, and 

 a true ulcer is formed, which commonly fpr,ead3, although 

 in a flow way. 



Thefe appearances arife firft from the gradual lofs of the 

 true found cuticle, which the difeafed cutis cannot re-produce. 

 As a kind of fubflitute for this want of cuticle, an exuda- 

 tion takes place, and forms a fcale. The matter afterwards 

 acquiring more confillence, at lafl forms a fcab. However, 

 before the difeirfc has attained this condition, the cutis has 

 ulcerated, after which the difcharge is more like true pus. 

 When this form of the lues venerea attacks the palms of the 

 hands and foles of the feet, where the cuticle is thick, this 

 latter part firfl becomes feparated, and peels off. A new 

 one is immediately formed, which alfo feparates. In this 

 manner, a fcries of new cuticles take place, in confequcnce 

 of fcurfs not being fo leadily formed as on the common flcin. 

 When the difeafe is confined Lo the palms of the hand<!, or loles 

 of the feet, Mr. Hunter mentions, that there is difliculty in 

 determining whether it is vfenercal or not : becaufe moft dif- 

 eafes of the cutis, in thefe fituations, produce a fcparation 

 of the cuticle, attended with the fame appearances in 

 all, and having nothing charaCleriRic of the venerea! dif- 

 eafe. 



When the affefted part of t^ie flcin is oppofed by another 

 portion of flcin, which keeps it in fome degree more moift, as 

 between the nates, about the arms, between the fcrotum and 

 the thigh, in the angle between the two thighs, on the red 

 part of the lip, or in the arm-pits, the eruptions, inftead of 

 being attended with fcurfs and fcabs, become accompanied 

 by an elevation of the flcin, which is fwollea with extravafated 

 lymph into a white, foft, moiil, flat furface, which difcharges 

 a white matter. 



A venereal eruption often attacks tfiat part of the fingers 

 on which the nail is formed. Here the difeafe renders that 

 furface red, which is feen fliining through the nail ; and if 

 allowed to continue, a fcparation of the nail takes place, 

 fimilar to that of the cuticle in the above cafes. However, 

 Mr. Hunter ftates, that there cannot be the fame regular 

 fuccefilou of nails, as of cuticles in other inftances. 



Such furfaces of the body as are covered with hair may 

 alfo be attacked, and the hair feparates, and cannot be pro- 

 duced as long as the difeafe lafts. 



Venereal Affed'ions of ihe Parts about theThroat. — Accord- 

 ing to Dr. Adams, the venereal ulcer in the throat is always, 

 what may be termed, a foul ulcer. Though its edges are defined, 

 its furface is always ragged and uneven, of a complexion 

 which can never be miftaken for a clean or healthy fore, that 

 is, for a fore difpofed to heal. The pus is of various colours, 

 from the afli-colour to the duflcy brown. From the nature 

 of the parts, a fcab cannot be formed, fo that the ulcerous 

 appearance is never interrupted. Its progrefs is more rapid 

 than on the flcin, as every adlion of inflammation, ulceration, 

 or healing, is always more rapid in thefe very fanguiferous 

 parts. It is rarely attended with pain. On Morbid Poifons, 

 p. 167. edit. 2. 



When the throat, tonfils, or infideof the mouth, ar« af- 

 fefted, it is the nature of the difeafe to make its appearance 

 at once in the form of an ulcer, without much previous 

 fwclling. 



The venereal fore-throat fliould be mofl carefully difcrimi- 



nated from others, a thing that is not always at firfl very 



eafy ; for fores in this fituation, which are really fyphilitic, 



femetimes have much the fame appearance as others which 



II are 



