LUES VENEREA. 



are not fo. It is the character, however, of a venereal 

 fore-throat to be^in with ulceration of the furface of the 

 parts. Now, as Mr. Hunter has explained, it is the nature 

 of feveral other dileafes, in the fame fitiiation, not to pro- 

 duce direftly this kind of ulceration. One of thefe is com- 

 mon inflammation of the tonlils. The inflamed place often 

 fuppurates in the centre, fo as to form an abfccfs, which 

 burfts by ?. fniall opening ; but never looks like an ulcer, 

 that has bo^un upon the furface, like a true venereal fore. 

 The cafe, jullnow mentioned, is always attended with too 

 much inflammation, pain, and fwelling of the parts, to be 

 venereal. Alfo, when it fuppurates and burfts, it fubfides 

 directly, and it is generally attended with other inflammatory 

 fymptoms in the conftitutio.T. 



Notice is likewife taken, by this moft celebrated furgeon, 

 of an indolent tumefaction of the tonfils, which is peculiar 

 to many perfons of a fcrofulous conftitution. The complaint 

 occafions a thicknefs of fpeech. 



Sometimes coagulable lymph is thrown out on the furface 

 of the parts affevted, and produces appearances which are 

 by fome called ulcers, by fome^lloughs, and occafionally by 

 others, putrid fore-throats. The cafe is attended with too 

 much fwelling to be venereal ; and, with a little care, it may 

 eafily be dillinguifhed from an ulcer, or lofs of fubftance. 

 However, when this difference is not obvious at firft fight, 

 it is proper to endeavour to remove fome of the lymph, and 

 if the furface of the tonfil underneath fliould appear to be 

 free from ulceration, we may conclude, with certainty, that 

 the difeafe is not venereal. Mr. Hunter ftates, that he has 

 feen a chink filled with coagulable lymph, fo as to appear 

 very much like an ulcer ; but, on removing that fubftance, 

 ths tonfil underneath was found perfedlly found. He adds, 

 that he has feen cafes of a fwelled tonfil, having a flough in 

 its centre, which flough, before its detachment, looked very 

 like a foul ulcer. The ftage of the complaint, he fays, is 

 even more puzzling, when the flough has come out ; for 

 then the difeafe has moft of the charadters of the venereal 

 ulcer. Whenever he met with the difeafe in its firft ftage, 

 he always treated it as if it had been of the nature of eryfi- 

 pelaJ, or a carbuncle. When the complaint is in its fecond 

 ftage, without any preceding local fymptoms, he recom- 

 mends the praftitioner to fufpend his judgment, and to wait 

 a tittle, in order to fee how far Nature is able to relieve her- 

 felf. If there fliould have been any preceding fever, the 

 cafe is ftill lefs likely to be venereal. Mr. Hunter informs 

 us, that he has feen a fore-throat of this kind miftaken for 

 venereal, and mercury given till it afiaded the mouth, when 

 the medicine brought on a mortification of all the parts con- 

 cerned in the firft difeafe. 



Another complaint of thefe parts, which Mr. Hunter 

 reprefents as being often taken for a venereal one, is an 

 ulcerous excoriation, 'which runs along their furface, be- 

 coming very broad and fometimes foul, having a regular 

 termination, but never going deeply into the fubftance of 

 the parts, as the venereal ulcer docs. No part of tlie infide 

 of the mouth is exempted from this ulcerous excoriation ; 

 but Mr. Hunter thought, that the difeafe moft frequently 

 occurred about the root of tlie uvula, and fpread forwards 

 along the palatum moUe. He remarks, that the complaint 

 is evidently not venereal, fince it does not yield to mercury. 

 He has feen thefe ulcerous excoriations continue for weeks, 

 without undergoing any change, and a true venereal ulcer 

 makes its appearance on the furface of the excoriated part. 

 He fays, that the excoriations in queftion have been cured 

 by bark, after the end of the mercurial courfe, which cured 

 the fyphilitic fore. 



This author defcribcs the true venereal ulcer in the throat 



as a fair lofs of fubftance, part being dug out, as it werei 

 from the body of the tonfil ; it has a determined edge, and 

 is commonly very foul, having thick white matter, like a 

 flough, adhering to it, and not admitting of being walhed 

 away. Ulcers in fucli fituations are always kept in a moift 

 ftate, and the matter cannot dry and form fcabs, as it does 

 on fores upon the fl<;in. The ulcer is alfo much more rapid 

 in its progrefs, and generally has thickened edges. Hunter 

 on Venereal Difeafe. 



Dr. Adams, after reminding us not to confider every rag. 

 ged ulcer of the throat as certainly venereal, takes occa- 

 fion to remark, that he has feen more than one of this 

 defcription, which has healed whilft he has been making up 

 his mind, whether he fliould falivate his patient. He fays, 

 "the only diftinftion I know between thefe and true vcne- 

 real ulcers, is that the former are ufually attended with 

 more pain, the edge is alfo for the moft part lefs defined, 

 and the furface itfelf is more irregular ; the fever too, if any 

 attends, is not fuch as we have defcribed in fyphilis. But 

 the venereal ulcer is not always entirely free from pain, and 

 there is generally fome irregularity in its furface ; the fever 

 too, we have remarked, is often flight. Happily, this in- 

 tricacy does not often occur, but often enough to teach us 

 not to value ourfelves on a hafty decifion, when a little delay 

 will be unattended with danger, and perhaps fave our patient 

 a tirefome and unneceflary procefs. By watching the ulcer 

 attentively, we fliall be able to obferve wliether it continues 

 to fpread regularly, though flowly, ftill retaining its cha- 

 rafter, and not healing in any part. If this (hould continue 

 a few days, we fliall have no reafon to doubt its fyphilitic 

 charafter; but if the progrefs is flow, there can be no harm 

 in a further delay, the only inconvenience attending which, 

 will be the importunity of your patient. If, as is fome- 

 times the cafe, from the nature of the part, and the irrita- 

 bility of the conftitution, the progrefs of the ulcer fliould 

 be quicker, the charafter in all other refpefts well defined, 

 and the hiftory of the cafe leading to a fimilar conclufion, 

 we may, by ufing every poflible means of introducing mer- 

 cury, eafily accelerate our courfe. This will rarely be very 

 difficult, becaufe the fame irritability of conftitution which 

 produces an ulceration more rapid than ufual, is for the moft 

 part attended with quicker fuiceptibihty of the mercurial 

 irritation. i 



" The fame directions are applicable, whether the ulcer 

 is feated on the tonfils, uvula, or palatum molle, or any of 

 the neighbouring parts, excepting the tongue, in which cafe 

 the progrefs is flower, the edges confequently thicker from 

 the ftruclure of the part, and the pain and inconvenience 

 greater from the fame caufe?, and alfo from its particular 

 offices." (Adams on Morbid Poifons, p. 167, 16S.) Ac- 

 cording to Mr. Hunter, lues venei** fometimes produces a 

 thickening and hardening of the tongue. We have feen a 

 cal'e or two, in which this part has been ftudded over with 

 largifli tubercles, or hard lumps, which yielded to mercury. 

 We doubt, however, whether thefe inftances were really 

 fyphilitic. 



Venereal AffeShns of the Bones, Periojleum, Fafci£, and 

 Tendons. — Nodes-fyphilitk Pains. — Thefe complaints are 

 nodes and pains in the bones. A fwelling of the parts enu- 

 merated, originating from a fyphilitic caufe, receives the 

 appellation of a node. We have already obferved, that 

 Mr. Hunter divided the parts in which fecondary fy.mp- 

 toms manifeft themfelves into two orders ; the firft compre- 

 hending the fl<in and parts about the throat and mouth ; the 

 fecond, the bones, pcriofteum, fafcia:, and tendons. Thefe 

 latter ftructiires do not in general become affedled till the 

 dil'eafe has troubled the patient a confiderable time, nor 

 4 E 3 before 



