LUES VENEREA. 



tioners. The common methods were chiefly empirical, and 

 it was not until towards the beginning of the eij;hteenth 

 century, that the treatment of the venereal difeafe began to 

 be regulated by fcientific principles. 



In the elegant edition of Aphrodifiacus by Boerhaave, a 

 full accou:;t may be feen of circumftances confirming the 

 preceding ftatemcnt. 



Wlioevcr willcoufvilt Wifeman, one of the moft refpcftable 

 authors we have in furgery, will fmd that the fymptoms of 

 the venereal difeafe were in general much more fevere in his 

 time than they are at prefent, and at the fame time that the 

 mode of praftice was ftill much feverer. In claps, large and 

 repeated dofcs of draftic purges, calomel, and turpeth mi- 

 neral were the medicines employed, even in the inflammatory 

 ftatc of the difeafe, and fomc turpentine remedies were given 

 to complete the cure. Venereal fores were powdered with 

 red precipitate, and drefled with the moil acrid and ft.imu- 

 lating applications. In confirmed fyphilis, the hot falivating 

 method of treatment was adopted ; the patient was crammed 

 into a fmall room heated with a (love ; the admittance of 

 frefli air was prevented by blankets put up at the door and 

 windows ; and the patient himfelf was furroundcd with a 

 fcreen. There he fat, half fuffocated in his own hot putrid 

 atmofphere, and was rubbed with mercurial ointment, until 

 his tongue generally lolled out, and the inlide of his mouth 

 was covered with floughs. In this hideous pickle it was 

 cullomary for him to lie from twenty-five to thirty days. 



It is no wonder, as Mr. Deafe has obferved, that many 

 fell viftims to this prepollerous mode of treatment, few con- 

 ftitutions being able to endure it, and no conilitution efcap- 

 ing without material and permanent injury. 



Our Enghfli Hippocrates, the great Sydenham, lays it 

 down as an axiom, that, as the venereal virus is of a very 

 inflammatory nature, the principal end to be aimed at in the 

 treatment ought to be evacuation. In gonorrhoea he advifes 

 llrong draftic purges, which are to be perfifted in for a long 

 time. The firft fourteen days of the difeafe he purges the 

 patient every day ; then every fccond day ; and, towards 

 the latter end of the cafe, twice a week. Should the cure 

 advance but flovvly, eight grains of turpeth mineral, given 

 twice or thrice, at due intervals, Sydenham reckons extreme- 

 ly effeftual. Where purgatives are rejefted by the mouth, 

 he fubititutes clyfters. Balfam of Mecca, or Cyprus tur- 

 pentine clofes the cure. He thinks injeftions do much more 

 mifchief than fervice ; and is averfe, in thefe cafes, to the 

 ufe of mineral waters, and decoftions of the woods. 



As Sydenham does not account mercury a fpecific, in the 

 cure of lues venerea, only inafmuch as it is pofleffed of a 

 fuperior efScacy in exciting falivation, he confiders as ufelefs 

 and hurtful all preparation, as bleeding, purging, or bathing, 

 before putting the patient into a falivation. He thought 

 that the lefs the patient was weakened, the greater was the 

 probabihty of a cure. His whole attention, in the treat- 

 ment, is to ifeep up a high degree of fitlivation. If the 

 rubbing does not have this efi^eft, he gives turpeth mineral, 

 or calomel ; and, of the latter medicine, he gives a dofe 

 once a week, for fome months after the cure is apparently 

 efFe£led, for fear of a relapfe. He is againll carrying off, 

 by purging, any remains of the fpitting after the courfe is 

 over ; and, during the whole treatment, allows the patient 

 fuch light meats as may be defired. 



The methods of treating lues venerea,' as laid down by 

 Wifeman and Sydenham, were for a long time followed, 

 throughout Europe, .with no material variation. At length 

 the celebrated Aftruc gave one of the moft elaborate trea- 

 tifes on this diftemper ever publiflied. 



The treatment of a gonorrhoea he confiders at three dif- 



ferent periods. In the firft, or inflammatory ftage, he 

 direfts us to employ large and repeated bleedings ; and 

 thinks, that the mdication for copious bleedingJs as ftrongly 

 pointed out in this cafe, as in that of a peripneumony, or 

 dyfcntery. He orders large quantities of cooling emulfions 

 to be. frequently drunk, the bowels to be kept open with 

 emollient glyfters, opiates, if the fymptoms are violent, 

 cooling injeflions, fomentations, poultices to the penis and 

 perineum, and a very flender regimen. In the fecond ftage, 

 when the inflammatory fymptoms have fubfided, after 

 purging two or three times with jalap, diagredium, or ca- 

 lomel, he has recourfe to mercurial triflions every fecond 

 day, to be more immediately employed about the parts of 

 generation and perineum. He continues the fame fevere 

 regimen. In the third ftage, he completes the cure by fome 

 of the turpentines, mineral, acidulated, vitriolic, or fteel 

 waters, or the common aftringents. He reprobates aftrin- 

 gent injeftions. In what he terms the dry gonorrhoea, he 

 pufhes the antiphlogiftic treatment much farther ; for he 

 even bleeds every fourth hour. ^ 



In the cure of fyphilis, Aftruc prefers falivation by mer- 

 curial friftions. He enters into a long defcription of the 

 ncccfiary previous preparation ; bleeding, purging, warm 

 bathing, medicated broths, and flender regimen. He fays, 

 it is feldom we can difpenfe with lefs than ten baths ; more 

 generally, he orders twenty. After this courfe of bathing, 

 the bleeding and purging muft be repeated. He then has 

 recourfe to the mercurial friftions, which he fo directs as to 

 keep up^nremittingly a foil regular fpitting, from two to 

 three pints in twenty-four hours, until the cure is com- 

 pleted. The patient is then cleanfed in a warm bath, and 

 purged. 



Not long after Aftruc's work made its appearance, prac- 

 titioners becapie extremely divided in opinion as to the me- 

 thod of adminiftering the mercurial friftions, for the cure of 

 lues venerea. Some of the moft refpeftable followed the 

 plan laid down by Aftruc ; while the greater number of 

 praftitioners in France followed the Montpelier mctliod of 

 extinftion j" that is, after having firft made the patient take 

 twenty or thirty warm baths, and kept him for fome time 

 on a very flender regimen, the fridlions were fo adminiiiered 

 as not to raife any fpitting, and thus continued for three 

 or four months, until the venereal virus was totally eradi- 

 cated. 



The celebrated Van Swieten, in the fifth volume of his 

 Commentaries on Boerhaave's Aphorifms, adopts, in a 

 great meafure, the opinion of hisiUuilrious mafter in treat- 

 ing of this difeafe. In the treatment of gonorrhoea, if we 

 except his difapprobation of bleeding, which he thinks is 

 very feldom neceflary, we find nothing new : for he follows 

 the general mode of praftice, and effefts a cure chiefly by 

 purgatives. 



In the treatment of ftriftly venereal cafes, he gives a pre- 

 ference to falivation raifed by internal mercurials, inftead of 

 employing the undion. He thinks that the quantity of 

 mercury, introduced into the fyftem, is much better afcer- 

 tained, when mercurius dulcis three times fubhnied, or white 

 precipitate, is made nfe of, in lieu of fridions with mer- 

 curial ointment. He confiders that the quantity of mer- 

 cury, introduced in this latter method, muft be uncertain; 

 and that as it does not pafs out of the fyftem as readily as 

 faline mercurials, it may accumulate, and be depofited in 

 dangerous quantities, in different parts of the body, and be 

 produAive of the worft confequences. But, above all other 

 methods of curing the difeafe. Van Swieten prefers the well 

 known folution of corrofive fubhraate in brandy, or fpirits. 

 By this medicine, which was in general ufe in St. Mark's 



hofpital, 



