SECTION III.

TREATMENT OF IMPOTENCE.

IN venturing upon this part of the subject, it will be as well, first,

to distinguish those cases that are curable from those that admit of no

relief. Among the latter may be enumerated all those arising from an

original or accidental defect in the organs of generation. Where, also,

old age is the cause, little is to be done: medicines are of no avail,

and temporary stimuli not unfrequently worse.

That certain medicaments, aliments, and so forth, do possess an

_aphrodisiac_ power, is not to be denied; but when adopted by those

weak beings, whose bodies are either worn out by age or excess, and who

pin their faith to such restoratives, the little remaining sensibility

in their frames, the source of life and energy, can not sustain the

shock of reaction; and the result is, total annihilation or death.

From what has already been stated, it will be perceived, that the mind

exercises no inconsiderable influence over the functions of the organs

of generation: and as the state of the mind depends upon the particular

circumstances under which it may be placed, any attempt to establish a

code of instructions, applicable to every instance in which a sportive

fancy, or disturbed imagination, constituted the prevailing cause,

would be abortive, and might be considered as pandering to a vicious

and depraved appetite, whereas the object of this treatise is only to

encourage the diffident, to assist the afflicted, and render a service

to those legitimately deserving it.

As excess in sexual indulgence impairs the generative power, no less

injurious may entire abstinence be considered. The due exercise of an

organ tends to its perfection, as the neglect or misuse of it, to its

impairment. Besides, there is not any wonderful virtue in abstaining

from the proper use of the sexes. Why, in the name of morality, were

such powerful impulses and desires bestowed upon us? Why were such

wonderful organizations given to us, if they were not originally

designed to be used by every one who is possessed of them? Society,

in its present form, is not perhaps constructed with a philosophical

regard to our own natural instincts, and our own original rights.

Among the causes that induce _impuissance_, or that distressing

condition known under the cognomen of _nervous debility_, there is

not one more reprehensive than the unworthy and pernicious practice

of self-abuse. It is much to be regretted, that some medical writer,

of talent and estimation in society, has not turned his attention to

the subject, and given the influence of his name in denouncing to the

world the misery and devastation which are the unerring consequences of

this sordid and solitary vice. It is indeed an unpleasant and thankless

task; and there probably exists in most minds, an unwillingness to

enter upon a subject in which there is so much difficulty in selecting

language sufficiently appropriate to exhibit the folly in its true

colors, without offending the ears of the chaste and virtuous.

But a question of such paramount importance should not be sacrificed

to any false and prudish notions of delicacy; I shall therefore offer

such observations, as I may think calculated to check the progress

of a vice, that has done more to demoralize the human mind than the

whole catalogue of existing causes besides. It may be deemed an

exaggeration, when it is stated that full three fourths of the insane

owe their malady to the effects of masturbation: but the assertion is

corroborated by one of the first writers on medical jurisprudence,

and is fully borne out by the daily experience of proprietors of

lunatic asylums. The practice of self-abuse usually has its origin

in boarding-schools, and other places where young persons congregate

in numbers; and there are few of us who may have observed the vice

practised, although it may be unpleasant to avow as much, that could

resist the contamination.

“One sickly sheep infects the flock,

And poisons all the rest.”

And thus it is, though ninety-and-nine be pure and spotless as

the driven snow, if the hundredth be immoral, the poison is soon

disseminated, and the whole flock become initiated into a vice, which,

if indulged in, will blast their intellectual faculties, and probably

consign them as outcasts of society; rendering them slavering idiots,

or the inmates of a lunatic asylum. It is not only in private schools

that this sin rages, our public foundations and colleges are not exempt

from it. The heads of our universities are particularly scrupulous

in driving from their neighborhood the frail fair, lest they should

contaminate the votaries of learning; while a vice far more degrading

in its practice, and infinitely more baneful in its effects, rages

within the very sanctuaries of classic lore. Many a brilliant genius

has sunk into fatuity beneath its degrading influence. Loss of memory,

idiocy, blindness,[15] total impotence, nervous debility, paralysis,

strangury, &c., are among the unerring consequences of an indulgence

in this criminal passion. I need not bring a greater proof of the dire

effects of an indulgence in the practice of masturbation, than the

deplorable state of mind to which it reduced one of our greatest poets.

The treatment of this delusive and mentally annihilating propensity,

falls equally within the province of the philosopher and the physician.

Without a total abandonment of the practice, the case is hopeless; and

he to whom the consequences shall have been portrayed and heeds them

not, is unworthy of our sympathy, but deserves the evils he entails

upon himself.

Now, as the consequences of all criminalities continue to ensue so

long as the provocative be kept up, it is very evident that, as a

first step toward the restoration of order and health, the cause

must be removed or withheld. The mere will or resolution is seldom

sufficient: virtue, like vice, has its allurements, and those belonging

to the former must be called into requisition as antagonists to the

snares of the latter. Physic can not check bad principles, or bad

indulgences. No method is or can be superior to that full employment

of the mental faculties on noble and intellectual subjects, on objects

worthy the high ends for which Nature has adapted them. And though

the difficulty will be great in inducing new and good habits, to the

exclusion of such as are unworthy and degrading, yet the effectual

accomplishment of such a resolution is not of uncommon occurrence; and

the sufferer may be placed under circumstances where good habits may

be more frequently called into action naturally, to the exclusion of

vicious propensities. The time should be well filled, so as to leave

no room for flying to the various usual sources of amusement that fill

up the life of the thoughtless and gay. Every hour and every minute

should be provided for, so as to exclude the admission of idleness and

sloth, the forerunners of mental and bodily disease. Studies connected

with education should be encouraged. Modern languages have a great

claim on the consideration of all who are engaged in business to any

extent, and are of incalculable use after they have fulfilled the

immediate end for which their culture is here recommended. The various

sciences bearing more or less on the pursuits and employments of

every man, are earnestly recommended to the choice of the unfortunate

victim of sensuality. Geology and botany would call him into the

healthful fields, or fill up his time by his fireside, in studying the

many excellent works on those subjects: the still higher utility of

chemistry, as being made of practical use in almost every business,

and demonstrating the else unintelligible phenomena of a multitude of

natural processes and changes, may be held up as another inducement to

call forth his best energies.

Travelling, to those who can afford the expense or the time, is one of

the best means of conquering this baneful habit. The numerous objects

thereby presented to the eye of the invalid in the manners, government,

and productions of art and nature, of the countries he visits, are an

incessant source of pleasing and useful excitement, and can not fail,

especially if the traveller be accompanied by an intelligent and moral

friend, to weaken and eradicate the bad impressions of the past.

To diverge, and at the same time to conclude this part of the

subject, I have only to offer a few remarks relative to the medical

and therapeutic treatment of those cases of impuissance, that

age, disorganization, and total incapacity, do not exclude from

consideration. I have already expressed my belief that generative

imbecility is consecutive to general debility; hence, whatever tends

to improve the latter, tends also to remove the former. The diet,

therefore, should be full and generous, with a liberal proportion of

spices; but all stimulating liquids, such as wine, brandy, and the

rest, should be avoided.

Bathing, in its various forms, constitutes no unimportant feature in

the treatment; the cold plunging, the tepid shower, the douche, the

warm and the vapor baths, possess their several influences. The various

medicines that come under the denomination of aphrodisiacs, are not

wholly uninfluential, such as stomachics, aromatics, gums and balsams,

oils, musk, opium, cantharides, strychnine, and others; but as their

administration can only be permitted under professional direction,

no real utility can follow any specification or formulary of their

proportions.

OTHER FORMS OF SEXUAL DEBILITY.

INVOLUNTARY seminal emissions are oftentimes very serious, distressing,

and intractable. They may be produced in two ways—from continence, or

by a high degree of morbid irritability or weakness. The latter is by

far the more frequent; for the treatment of the former is obvious,

and generally effectual. The difference between seminal discharges in

persons of full health, and those morbidly weak, is very opposite: in

the former it is consequent upon an erection, followed by an act of

coitus; while in the latter both are absent. The general debility in

the generative system, inseparable from morbid irritability, occasions

both a failure in the erection of the penis, and an inability to

retain the fluid in the secreting organs. There is no doubt that this

disposition to seminal emissions, conjoined as it generally is with

more or less deficiency of the _vis virilis_, is too often owing to the

habit of self-abuse in early age. The testes usually wither in these

cases, and the patient becomes nearly, if not entirely, impuissant.

Sometimes these cases are attended by an excessive irritability of

the bladder, accompanied by pains in the loins, kidneys, &c. Their

treatment consists in taking nutritious and digestible food, to impart

strength and invigorate the constitution. Stimulants are at the same

time to be carefully avoided, except where great languor and lassitude

prevail. Abstemiousness in liquids is to be enjoined. Habits of a

relaxing nature should be avoided; the patient, instead of sleeping

on a soft, downy bed, should lie on a firm mattress; the air of the

room should be preserved at a moderate temperature, and but few hours

should be allotted to sleep; he should pass much of his time in the

open air in a cool atmosphere; taking frequent and moderate exercise,

so that it does not occasion fatigue. Cold bathing is a very important

and essential part of the treatment to be observed; the daily use of

the _bidet_, or the frequent application of a towel, dipped in cold

water, to the testes, applied twice or thrice a day, or the _douche

bath_, will be found of much service. To prescribe formulæ for the

various temperaments subject to this affection would be to transcribe

all the tonics from the pharmacopœia: they are severally useful, but

the various preparations of iron surpass all others. During this

treatment the state of the mind should not be neglected: no lascivious

idea should be for a moment encouraged, nor should the imagination be

permitted to wander over the works of fiction or romance in any way

connected with matters of love.

It not unfrequently happens that patients affected with these

complaints are apt to despond, and become miserably depressed in

spirits; to remove which, every recreation should be encouraged to

prevent them pondering over their own situation, and, if possible,

to divert the mind from gloomy ideas: lively and agreeable company

should be courted; theatres, concerts, or any other rational amusement

consonant with the principles of the patient, should be visited or

pursued, and by an uninterrupted perseverance in this mode of treatment

for a sufficient length of time, I have seen the most beneficial

results arise. The great art and difficulty in treating these cases

consist in giving tonics to a certain extent and no further—avoiding

excess, whereby we stimulate and produce fever; or depletion, and

induce debility. Early hours, fresh air, exercise, attention to diet,

the shower bath, topical application of cold, with properly regulated

sexual intercourse, are rarely ineffectual in curing the disease.

I could narrate many instances wherein the sexual desire declined on

the intervention of ordinary illness; any powerful mental solicitude

will suffice, but such a cause is commonly remediable. Where the

cause is traceable to excesses and pernicious indulgences, if not

accompanied by disorganization, hope should not be abandoned; but the

patient should not cling to, or hang his reliance upon, hole-and-corner

speculators, or their advertised specifics. He should consult men

legitimately engaged in the profession, in which, perhaps, more talent

and honor are concentrated, than in any other department of science.

ON PILES OR HŒMORRHOIDS.

AS this disease is generally considered to be of a delicate nature,

and one about which the afflicted are unwilling to speak, we shall

say a few words on them. Piles constitute a disease that may be very

slow or very rapid in its progress. The patient complains of an

occasional itching or soreness at the rectum after an evacuation, more

particularly if subject to constipation, or if he be an irregular

liver: when, after a while, he will be surprised on discovering,

subsequent to some straining effort, a knot of elastic but irregularly

formed tumors, of a size varying from a hazel-nut to a horse-bean,

springing out apparently from the rectum, that in a few days, if they

continue, will become sore, and probably be attended with a discharge

of blood.

[Illustration:

1. Rectum.

2. Hœmorrhoids.

3. Perineum.]

Another patient will experience similar symptoms, as regards the pain,

swelling, and discharge of blood, except that they will be increased

in severity, and be more transitory in their appearance and stay.

Upon examination, a perceptible difference will be discovered. In the

former instance the tumors will be seen to proceed from the outer edge

of the rectum, and will be found to be covered with the common skin.

Professional men designate this form of the disease “External Piles.”

[Illustration:

1. Inner part of Rectum.

2. Orifice of Rectum.

3. External Piles.

4. Internal Piles.]

In the latter, the tumors are, as it were, squeezed out of the rectum,

and swell in a very short space of time to an enormous size. They

are of a much more vivid blood-red color, and will be found to be

covered only by the lining membrane of the lower gut. These are called

“Internal Piles.”

[Illustration:

1. Inner part of Rectum.

2. Orifice of Rectum.

3. Internal Piles.]

Now piles are nothing more nor less than _dilated veins_, like varicose

veins in the leg or any other part. The office of veins is to receive

the surplus blood of the arteries, after having parted with that

necessary supply for the nourishment of every structure they are

severally distributed to, and to convey it back to the circulating

organ, the heart—and the mesenteric hœmorrhoidal veins, from their

dependant and confined position, the circulation in and above them

being liable to so many interruptions from the frequent hardened state

of the fæces in the rectum, become distended with blood, which acting

really like a wedge, dilates them in time to the size we meet them.

On the removal of the cause, the blood flows on, and the swelling

subsides, and the patient feels no further inconvenience until a

recurrence of the pressure. After repeated attacks, the veins become

inflamed, and lymph, a sort of defensive mucus, is “thrown out” on the

cellular membrane covering the veins, and becomes organized into an

indurated texture, which increases with each attack of inflammation,

and at last gives them that fleshy appearance which resembles a

specific growth (see annexed cut).

[Illustration]

The distinction between External and Internal Piles is as follows: In

both instances the same veins are diseased. In external piles, the

lowermost portion of the hœmorrhoidal veins are dilated, and are thrust

by the outer side of the rectum, carrying before them the common skin,

which dilates and constitutes the external coat of the piles. The

rectum is a portion of gut of four or five inches in length, and of

nearly a uniform width; the lower end, constituting the orifice, is, as

it were, tied round with a contracting and yielding band of muscular

fibres, forming a muscle called the _Sphincter Ani_. It is a muscle

of great power, and, from its connexion with the neighboring muscles

of similar strength, helps to afford that support to the contents of

the pelvis, that otherwise would descend, and be always forming a

projecting tumor. External piles consist, then, of a protrusion of the

hœmorrhoidal vein or veins between the cellular union of the sphincter

with other muscles, constituting, in fact, a hernia or rupture in the

perinœum. Internal piles is that condition of the hœmorrhoidal veins,

where, from their dilatation, they become protruded with the fæces,

when, from the contraction of the sphincter acting like a ligature,

they can not regain their situation until emptied of their contents.

Inflammation soon ensues, and the various changes I have and shall

hereafter consider take place.

Having stated the cause of piles, namely, pressure on, and thereby

prevention of, the circulation of the blood through the hœmorrhoidal

veins, it follows that persons mostly annoyed with constipation must be

the most likely to be afflicted with piles; hence, free and intemperate

livers, great wine-bibbers, feeble and relaxed constitutions, those,

again, who take little exercise, and pregnant women, and women who have

borne many children, seldom escape them. It is rarely that piles attack

people in the lower class of life, and those who have to work hard for

their livelihood and are much in the open air, which accounts for the

prevalence of this disease in the upper ranks of society. The treatment

of piles is very simple, if proceeded with at the commencement of the

complaint, the grand object being to prevent constipation. An excellent

adjunct to the cure of incipient piles, is the warm bath. Its tendency

to overcome local congestions, and thereby equalize the circulation of

the blood, is well known. The best medicine a hœmorrhoidal patient can

take is Turkey rhubarb, to be chewed freely, or castor oil, in doses of

one or two teaspoonfuls every morning, or some mild electuary, which

should be continued until the piles subside.

The diet during this treatment should be temperate and laxative. Fruits

should be used freely, and also coarse bread, rye and Indian mush and

molasses; wine and exhilarating stimulants being avoided, and, where

admissible, as much out-door exercise taken as possible. An excellent

plan is also to inject half a pint or more of cold pump or spring water

up the rectum every morning, and suffer it to remain for twenty or

thirty minutes, if possible. Where the piles have been of several days’

continuance, and are very much swollen, puncturing them with a needle,

and so relieving the tension by evacuating, or at least diminishing

their contents, that the obstruction shall be overcome, is serviceable.

After this, pledgets of lint dipped in cold water, the patient

preserving the horizontal posture, may be applied, or an astringent

lotion may be used.

Where there is much swelling and inflammation, leeches applied to the

neighboring parts will afford relief. It is impolitic, although some

surgeons recommend it, to apply leeches on the tumor, as the bites

are oftentimes very difficult to heal. Where the piles will admit of

it, attempts should be made to empty them, and press them to their

places, after which a pad may be worn to prevent their descent. In the

commencement of the disease, where there is much heat and itching, a

mild and astringent ointment will prove of considerable utility, and a

wash of powdered opium, dissolved in flaxseed tea, will relieve pain

and soreness.

A very excellent and practical method in the treatment of piles (the

internal I am now speaking of) is to deposite a pear-shaped bougie or

pessary in the rectum, and suffer it to remain as long as possible. The

wearing of bougies gives no pain or even uneasiness, and the patient

may pursue his or her ordinary occupation without hinderance: the

bougie should be worn from one to several weeks. It affords constant

pressure against and support to the dilated veins, and enables them to

regain their tone and strength; and I have known numerous instances

where a lasting cure has been effected. One of the most alarming

consequences of piles is hœmorrhage or bleeding; and it is really

wonderful what an extensive loss of that fluid a patient can sustain.

Day after day, and week after week, have I known instances of constant

bleeding from internal piles, by which the constitution of the patient

has been almost broken up. This symptom mostly prevails with females,

nor is it limited, although more prevalent, to those who are pregnant.

There is naturally a strong objection on the part of a delicate and

susceptible female to submit to a professional examination, and

consequently it is rarely done, until the urgent necessity of the case,

lest death should ensue, induces the patient to consult her medical

adviser, that he becomes acquainted with the real nature of the case.

Where there is ulceration of the piles, and they are very numerous,

and the bleeding frequent and profuse, the only effectual cure is

their removal. Where the operation is objected to, the next method is

to employ astringent enemata, which must be regulated by the medical

attendant.

The celebrated Weir’s balsam (248½ Grand Street) has the credit of

effecting miraculous cures. It is a medicine of deserved repute, and

ranks high with professional men. Pitch pills have been extolled.

Now, where piles, both external and internal, do not yield to the

means suggested, or the patient may not think proper to avail himself

of them, the next best step is their removal; and this is done either

by excision or by ligature. Both processes are safe in the hands of a

medical man, and are neither attended with any pain nor suffering worth

notice.

Among the annoyances incident to the rectum, is an occasional

preternatural contraction of the sphincter muscle. It is generally the

consequence of local irritation set up by purgatives, by which the

orifice becomes sore and excoriated, which, if not timely relieved,

ulcerates, constituting cracks also, and in process of time a portion

sloughs away, and the adjacent edges unite, and thereby diminish the

calibre of the opening. This disease _may_ be congenital, that is,

the individual may be born with a contracted or narrow sphincter. The

treatment, naturally enough, is to dilate the orifice, which is to be

attempted by the introduction of bougies, after the mode advised for

the cure of stricture, of which this in reality is a form. The cracks

of the sphincter are occasionally obstinate to heal; and the ulceration

will spread within the rectum. When that is the case, the application

of any stimulative ointment will promote a healthy action.

In inveterate cases division of the sphincter is necessary, which is

to be done with a scalpel, and the incision should be made from within

laterally, by which injury to the perineum is avoided. The operation is

very simple, and by no means painful or dangerous: the cure is perfect.

Appropriate medical treatment must not be neglected.

PROLAPSUS OF THE RECTUM.

[Illustration]

THIS disease is often confounded with piles; and as patients are

generally diffident in submitting to an examination, any extraordinary

protrusion of piles they denominate a falling of the gut. _Prolapsus

Ani_ is distinguished from piles by the muscular coats of the intestine

descending with the mucous membrane, and forming a bag, like a

pendulum, to the length of many inches; the rectum, in fact, becomes

everted, as we see the finger part of gloves when turned inside out;

and the inner membrane being highly vascular, and the vessels in a

congested state, it assumes a blood-red appearance. The case is here

well portrayed. Of course the disease occasions much inconvenience and

if not abated by appropriate treatment, serious consequences ensue.

Piles are most commonly the cause of prolapsus, when, from the frequent

and hard straining, the gut at last descends, bringing the piles with

it, which will be seen winding around the upper part. When that is

the case, the best treatment is first to apply a ligature round the

hœmorrhoids, and then return them and the rectum together. Where

the gut protrudes from relaxation of the sphincter, the treatment

depends upon local support, for which there are many contrivances.[16]

Astringent injections should also be used to give tone to the parts,

and medicines given to render the alvine evacuations less hurtful.

Children are very liable to prolapsus, but with them a return of the

fallen gut, and a brisk purgative is all that is needed to prevent a

repetition, provided proper attention be paid to the bowels afterward—a

disturbance of the latter being, in most instances, the cause. Where a

rectum has been for a long time the seat of disease, excrescences are

apt to arise, resembling warts: they may be removed without much pain,

and with perfect safety.

STRICTURE OF THE RECTUM.

THE rectum, it is presumed, is known to be the lower portion of the

intestines that leads to the outlet called, in domestic language, the

fundament. Now some writers assert that the rectum answers the same

purpose to the bowels generally, as the urethra does to the bladder,

while others contend that it is a receptacle for the fæces previous

to their expulsion. We are all sensible, I think, that it must answer

both purposes; but it is also evident that it is employed more for

the former than the latter purpose. The moment the rectum is full,

there is a desire to empty it, which is the best proof of its office;

but circumstances oftentimes forbid us, for even hours, obeying the

summons, which establishes its capability as a recipient. Well, the

rectum, consisting of muscular and membranous coats, similar to the

urethra, is alike subject to irritation, inflammation, and ulceration,

and imitatively gives forth morbid and other secretions. The rectum,

from its situation and office, is very obnoxious to disease; and in

addition to those already enumerated, it is extremely liable to become

strictured.

Neither age nor sex are exempt from this strictural change, although

it more usually selects the grown up and female portion of society.

It is, generally speaking, the consequence of constipation, or

the reverse—diarrhœa or dysentery—or it may follow in the wake of

child-bearing. Piles are a frequent precursor. The ordinary symptoms

are at first a slight difficulty in voiding the fæces, which assume the

form of the passage through which they have to pass, presenting at one

time a flattened tape-like shape, at others a spiral appearance, and

again the natural form, but of very small diameter.

As the disease advances, the pain increases, upon going to the

water-closet, and after the act may be observed a small or copious

discharge of mucus, or blood, from the anus. If the bowels be

constipated, there is necessarily a great deal of straining during

fæcation, that soon establishes spots of inflammation that rarely

resolve, but run on to ulceration; small lodgments then of fæcal

matter take place in the cellular membrane; and without detailing the

pathological phenomena, it may suffice to say, that sooner or later

the whole rectum becomes diseased, and fistula, with its attendant

miseries, lends a speedy help to close life’s brief pilgrimage.

Patients afflicted with rectal diseases lose flesh rapidly. From

the constant pain and annoyance they endure, their general health

gets undermined, the digestion becomes faulty, the countenance flags

and looks care-worn, hectic fever awaits the break-up of functional

regularity, and a lingering exhaustion closes the scene.

Stricture of the rectum is a curable disease; but the less complicated,

the greater are the chances of recovery. The principles of treatment

bear a near resemblance to those for stricture of the urethra. After

having ascertained the situation and size of the contraction, a

proper-sized bougie may be introduced, and suffered to remain as long

as it occasions no inconvenience. The introduction should be repeated

every or every other day, increasing the size of the bougie until the

dilatation be fully perfected. After vigilance is necessary to prevent

a recurrence, and the bougie can not with propriety be entirely laid

aside, or the disease will return with increased violence. There are,

however, cases that require more imperative means, such as the use of

the _bistouri_, an instrument for the division of stricture of the

rectum, which, if the resort be objected to, it behooves persons with

the premonitory symptoms to attend to them, that the operation may be

rendered unnecessary. There are many excellent palliative medicines

that the invalid will derive much comfort from in diseases of the

rectum; and enemata constitute a powerful means of relief. The title of

stricture of the rectum is fortunately more familiar than the disease

is frequent; and what is more consolatory to persons of feeble health,

the complaint seldom extends beyond two or three inches from the

orifice, so that it need not be feared beyond the reach of relief. See

annexed drawing:—

[Illustration:

1. Rectum.

2. Orifice of Rectum.

3. Stricture of the Rectum, with internal hæmorrhoids in

the lower portion.]

There are some surgeons who state all diseases to emanate from a

disordered liver, a weak stomach, or a “broken wind;” and there

are others in this town who are never consulted but they deem the

use of the rectum bougie indispensable. The limit to structural

disorganization of the bowel is not afforded by stricture; there are,

unfortunately, many diseases springing therefrom, and many totally

independent of such; but their detail here would exceed the titular

object of the book. Enough has been stated to convince any person

teased with any of the enumerated symptoms, that however simple may be

his malady in his own opinion, it is impolitic to overlook or neglect

it.

THE URINE.

WE shall conclude our treatise by a few remarks on diseases of the

urine, to which many are subject. Before proceeding to speak of them,

it is necessary, for a full understanding of the subject, to state,

that the urine is secreted by two bodies called _kidneys_, placed one

on each side of the back-bone, as is shown in the cut. After being

formed, the urine passes through the _ureters_ into the bladder whence

it is voided, as every one knows, occasionally.

[Illustration:

1—1. The Lungs.

2. The Stomach.

3—3. The Kidneys.

4—4. The Ureters.

5. The Bladder.]

The following diagram shows the bladder and its muscular coats, and

also its neck imbedded in the prostate gland. The bladder is seen

distended, and, of course, as detached from the body. The kidneys are

also seen—one in its natural state, the other divided to show its inner

structure: the kidneys and their ureters are crossed to save space in

the sketch.

[Illustration:

1. The entire kidney. 2. Its cortical, or secreting part. 3. The

papilla. 4. The pelvis. 5. The ureter. 6. The bladder. 7. The

detrusor muscle. 8. The sphincter muscle. 9. Prostate gland.

10. Neck of the bladder.]

The bladder and adjacent parts are seen more fully in the diagram at

the top of the succeeding page.

[Illustration:

1. Corpus cavernosum.

2. Bulb of urethra.

3. Membranous portion of ditto.

4. Prostate gland surrounding urethra.

5. Seminal vesicles.

6. The two vasa deferentia.

7. The ureters.

8. The bladder.]

It is a very common observation with patients, that they never were in

better health in their lives than at the moment of consulting their

medical adviser, except in the very particular malady, such as an

ulcered limb, a teazing cough, a gleety discharge, or an irritable

bladder, that they are seeking relief for; “they are quite well,” they

say, “in every other respect.” When illness attacks an individual, it

does not always announce its arrival by sound of trumpet. It does not

always come on like an apoplectic shock: some minor organization is

generally the first to indicate disturbance in the healthy economy by

even so simple a presage (I will take for example, more especially as

the ensuing remarks bear upon the subject) as excretion of disordered

urine. To resume; the patient will content himself, that the only

fault in his system is the disordered condition of his urine, and

he earnestly seeks for something to touch that particular symptom,

forgetting that trifling as he may fancy it, it is not merely owing to

the office of the kidneys and bladder, but to the blood itself, whence

the urine is formed, and to other circumstances in the economy that

influence it. Therefore, it is not merely the urine which is at fault,

but the state of it is a pretty good indication of the general state of

health; and when it becomes vitiated, the urine is generally, unless

restored to a healthy condition, a forerunner of some more serious

evil. Still there are many variations in the character and quality

of the urine, and each depending upon different causes—some upon a

disordered state of the fluids of the body, some upon one remote cause

or another, deranging the balance of the circulation, and inducing

excessive perspiration, and the like; and certainly not the least

important, nor the least influential, exist in the very structures

that make (as it were) and receive the urine, namely, the kidneys and

bladder. I may observe here, that chymists have detected upward of

twenty different substances, animal and saline, in its composition,

but in a state of complete solution. Of all these component parts, the

most important is an animal product named _urea_, which exists in about

the proportion of one in thirty to the water containing it, while the

other materials taken collectively, water excepted, yield only about

double the quantity of the urea: hence, when the urine is disordered,

its specific gravity[17] is increased or diminished, as the case may

be; according to the abundance of the urea, and the various proportions

of the saline ingredients of the urine, so is the urine thick, thin,

acid, or alkaline, pale, or what is called high colored. The various

conditions of the urine are ascertained by producing chymically certain

decompositions, or by suffering the urine to effect its own changes,

which, on being suffered to “stand,” sooner or later it will.

Healthy urine is perfectly transparent and of a light amber color;

it yields an odor when warm resembling violets. Its taste (for

pathologists trust not only to sight and smell) is saltish and

offensive. As the urine cools, it throws up what may be said to be a

“urinous smell.” As decomposition proceeds, the urine becomes cloudy,

thick, with shining floating patches on the surface; and lastly, a

thick deposite coats the bottom and sides of the vessel, the whole

giving forth at the same time a fetid ammoniacal exhalation, as is

perceived on entering public urinals.

The rapidity with which these several mutations occur, affords some

criterion of the healthy or disordered state of the excretion we are

talking about, and hence the usefulness of examining especially the

urine of persons laboring under any disorder of the urinary system and

functions connected therewith. A patient will complain, for instance,

of irritable bladder. The symptoms of that complaint, as far as pain

and frequent desire to micturate exist, very closely resemble those

affections known by the name of “Diabetes,” but which is distinguished

from the bladder affection in question by the quantity and character

of the urine. I purpose herein to enumerate, in as familiar a manner

as is possible, the various disordered states of the urine which my

experience has rendered me familiar with, and to present the same as

heretofore, in the form of cases that have fallen under my notice.

Now, the urinary disorders that I purpose to collect a description of,

and exemplify, may be thus enumerated:—

First, where too great a quantity of urine is voided.

Secondly, where too little is discharged; and also, where suppression

of it entirely occurs.

Thirdly, those states where the urine deposites a sediment, of which

two kinds are mostly prevalent, namely, the Lithates or Acid, and the

Earthy or Alkaline.

Fourthly, a brief exposition of the many but less frequent morbid

changes of the urine, in which certain salts and substances, not

existing in healthy urine, are precipitated or held in solution.

And lastly, to add a few to the number of those already presented

herein, of the infirmities of those organs which excrete the fluid

under consideration, namely, the kidneys and bladder.

ON INCONTINENCE OF URINE.

ALTHOUGH this is not the professional term for the disease I am

principally about to speak of, yet under this head will the reader, if

he be an invalid laboring under a complaint of this character, seek for

a description of his own case. Incontinence of urine implies a loss of

the retentive faculty of the bladder; but there is a species of disease

where micturition is carried to such an extent, that a patient will

attribute his leaky condition to the above cause. Not so, however,

is the case; the urine, in the disease alluded to, is generated or

excreted in great quantity, and the bladder merely fulfils its ordinary

duty. Of the affection known under the title of incontinence of urine,

most persons are aware that it is one of more frequent occurrence in

infancy than in adolescence; but the latter is by no means exempt.

In childhood it arises, in all probability, from drinking too much,

and the bladder becomes, during sleep, overloaded, and runs over; or,

perhaps, from the irritability induced by its distension, becomes

excited to action, and so empties itself, the drowsy state of the child

rendering it insensible to the passing circumstances.

The infirmity soon becomes a habit, which is often rendered worse by

the means taken to check it, namely, chastisement, which is highly

reprehensible. It is fortunately, however, a disease that wears itself

out as the child grows up; and it may at all times be materially

mitigated by a little care and attention, such as inducing the child

to micturate before going to bed, and even awakening it before the

anticipated time when it usually is attacked with the incontinence.

The last fluid meal, which should be a spare one, should be taken some

hours before retiring to rest; and if the complaint has gained much

ascendency, medicines which give tone to the bladder should be taken.

I have known the malady successfully removed, in a very short time, by

a combination of the sulphate of iron and quinine, and any sedative

extract, such as henbane or hops, given in small doses in the form

of pills. Female children are more susceptible of the annoyance than

males, probably owing to the shortness of the urethra. Every measure

tending to give strength to the child should be used, such as cold

bathing, fresh air, or a change of the same, especially if residing

in the city, to the country. Mechanical contrivances are to be had

to collect the escape of urine, whereby the offensive odor arising

from the continually soiled bed-linen may be avoided, and oftentimes

the fretting consequences of the urine passing over the person, which

induce excoriations and troublesome sores. There are contrivances for

both sexes. Where the disease prevails in mid-life, it is generally

traceable to early improvident habits, and of course is the result

of irritability and debility of the bladder. There are many patients

who can somewhat control the functions of that organ while awake, but

have no power over it when asleep. The treatment depends a great deal

upon the observance of abstemiousness both in eating and drinking:

a perseverance in chalybeate remedies, both taken and administered

internally (I have injected the bladder of a person subject to nightly

incontinence of urine with various tonic preparations, with very great

and permanent relief); the use of the warm bath, whereby the skin is

brought into healthier action (for it is generally arid, and parched

when much urine is voided), which tends to lessen the duty of the

kidneys and urinary system, should be adopted; nor should exercise,

that _pabulum vitæ_ of even all feeble persons, be disregarded. It is

of the utmost importance for the preservation of health, under all the

circumstances in which we may be placed. Escaping from this digression,

I now proceed to follow out the idea of the first paragraph of this

chapter, to treat of those complaints wherein the urine is voided in

excess. There is a disease commonly known by the name of diabetes,

wherein the prominent symptom is a continual aptitude to pass urine,

and in much greater quantities than the fluid consumed as ordinary

drink could supply. This is one form of ailment of this class; but

there is another, happily less inimical to life, and which, in the

order of its frequency and simplicity, should take precedence. It

is that state of health, where the patient is of that leaky habit,

that whatever he takes runs through him, and that very quickly too.

Of course, such a condition must depend upon a seriously-deranged

constitution: hence there is present a perpetual thirst, an entire

perversion of the perspiratory function, and a morbid condition of

many of the phenomena of life. Where this disease springs up in early

years, it becomes a habit proper to existence; and although it may not

seriously disturb the economy of the being so as to lessen the duration

of one’s stay here, yet it furnishes a source of much solicitude, by

depriving us of rest, and shutting us out from society.

The patient (for such he or she may be truly called, and the complaint

invades both sexes) appears to have a perpetual fever. Such is

the desire for drink, that attested cases record the circumstance

of individuals consuming from _one_ to _two pailfuls_ of water in

twenty-four hours! and I positively know an instance, at the moment of

writing this, of a child, fifteen years of age, consuming during the

night, notwithstanding a plentiful supply of liquids during the day,

a large jugful (two quarts) of water: the quantity of urine excreted

is nearly equivalent. In this case, the perspiration is profuse, and

the child enjoys tolerably good health, with the exception of being

occasionally nervous and hysterical. The case is under treatment, and

the quantity of fluid allowed is being daily diminished. The urine on

these occasions is aqueous, very pale, and of little specific gravity;

the properties of the urine otherwise are not altered. These cases

sometimes exist through life; and if they do not terminate fatally,

they ultimately enfeeble the health, and predispose the patient, or, in

other words, render him less able to combat with ordinary complaints

common to us all, and thereby tend to the break-up of his constitution.

There are many persons tipplers, not for the love of the specific

liquor, but from being always thirsty; and if we reflect a little, we

shall soon find how inclined we are to encourage the habit. Since the

introduction of tea into this country, what inordinate quantities of

that fluid are consumed by individuals. They must, of course, dispose

of it, after having drunk it: the stomach can not retain it, and it

escapes either by the skin or kidneys, more usually the latter. It is

no uncommon thing for nurses, washerwomen, and other females too, to

swallow nine or a dozen cups of tea at a sitting: they declare it is

their best meal.

Man is a great deal more careful of the quadruped world than the class

he belongs to himself. He will stint his horse drink, who works as much

beyond his strength as man does under his own, while he, the driver,

will swill till his mouth can scarcely receive another drop. The moral

of a volume might doubtlessly be expressed in very few words, but then

it would not be a volume, and, consequently, would not be purchased or

read; therefore, the proposition herein intended to be presented to

the reader would exist unheeded. It is one thing to observe, that we

all drink too much, or that too much fluids are hurtful to digestion

and other functions, the public require some illustration (which their

own reflection would furnish, if they used it), and hence this expense

of verbosity to prove the fact. As one of the consequences, then, of

too great an indulgence in fluids (I am here speaking of quantity

rather than quality), this form of complaint, wherein the patient is

perpetually desiring to urinate, is decidedly the result; and, as

all complaints have a beginning, this may be considered as the first

step toward setting up the several affections of the kidneys and

bladder hereafter treated upon. How important, then, is the arrest of

this practice. Where the inconvenience thus detailed is present, the

quantity of fluids must by degrees be diminished, the general state of

health must be studied. Dieting and warm-bathing are two sheet-anchors,

if properly applied. All remedies tending to afford strength to the

urinary system must be had recourse to; and where the bladder loses

any of its retentive power, I entertain the greatest benefit from an

injection.

The next form of urinary disturbance of a proximate nature to the

one just described, is also where the urine is discharged in large

quantities; but, unlike the former, excreted in greater abundance than

the supply. The character of the fluid is also different; it assumes

two appearances, modifications doubtlessly owing to the constitution

of the patient and the severity and length of the disease. It is known

by the name of diabetes: it is happily a complaint the least frequent

of urinary derangements, else, from its obstinacy and difficult

management, the slightest urinary disorder would excite much just dread

and apprehension.

The forms of the complaint thus vary: In the one instance, there is a

deficiency of the animal matter of the urine, namely, the urea, and in

the other, a superabundance of it. In the former instance the urine

is of a pale color, and transparent, and sometimes like clear water,

with a very faint slight odor; whereas, in the latter it is generally

of a higher color, and now and then so thick as to resemble brewer’s

porter: it is decidedly a disease of great debility. The symptoms are,

a wearisomeness and languor of the whole frame, a dry and crimpled

state of the skin, a sinking, gnawing pain at the pit of the stomach,

the bowels are obstinately bound, while a great thirst always prevails.

The body wastes to a mere skeleton, the discharge of urine being

almost constant, at least every hour, accompanied with a call that

must be immediately obeyed: the leading feature in the composition

of the urine, in addition to the varied presence of the urea, is the

saccharine matter contained therein. It rarely attacks others than

those who have led an irregular life, or else have suffered much from

other kinds of sickness.

Diabetes is supposed to depend upon a perverted action of the kidneys;

but there is little dispute of its being a malady involving the

whole process of animal economization. The quantity of urine got rid

of in a day has been known to amount to ten quarts; as the disease

continues, the patient becomes much emaciated, the feet swell, and he

sinks into a state of low hectic fever; the urine discharged continuing

all this time to exceed nearly double the amount of nourishment,

liquid or solid, that is taken, has given rise to the idea, that

water is absorbed from the atmosphere through the body. The disorder

is generally lingering, and, unless conquered, at last fatal. The

treatment embraces many remedies—bleeding, emetics, diaphoretics, and

sedatives, are mostly employed. It being a complaint involving the

necessity of constant professional watchfulness, a more lengthened

dissertation upon its peculiarities will but little serve the patient.

My own opinion is, that the invalid must look for recovery—presuming

the initiatory symptoms have been duly attacked and subdued—to careful

diet, fresh air, varied scenery, and cheerful society. Bathing, either

vapor or warm, is immensely useful; and, among the cases that have

travelled across my path (for patients laboring under diabetes, like

any other chronic ailment, generally take the round of the profession),

I have seen much and great good achieved by the frequent employment of

the bath.

As diabetes is mostly a sequence of some previous disturbance of the

urinary system, it the more behooves the afflicted to heed the first

noticial summons of attack: a handful of water will sometimes quench a

mouldering ember that, suffered to rise into a flame, an engineful can

not extinguish. I may add, there is no cause so destructive to virility

as these drainages from the system through the urethra—an additional

reason why they should be attended to upon their first appearance.

_Cases where but a small quantity of urine is voided, terminating in

suppression, of urine._—The most popular scientific synonymes for

complaints are but little understood by men really of education; for,

as yet, medical knowledge forms not one of the items of collegiate

lore, and few anticipate sickness to render such acumen necessary. The

term “Strangury,” from the frequency of its occurrence, is uppermost in

most men’s minds; and they use it on all occasions when there happens

an interruption to the process of making water. It is oftentimes

misapplied. Strangury implies a difficulty in voiding the urine, but

it does not include those cases wherein little is voided, because

there is little to void. The affection I am now about to make mention

of, is of the latter description. I have stated that the urine is

subject to a multitude of changes, that the human frame is constituted

to exist under a variety of circumstances, and that occurrences are

daily happening, wherein its integrity is put to the test. Excesses,

termed sensual, and others, which in themselves might destroy life,

are counterbalanced by what may be styled the _safety-valves_ of the

system. A violent fit of purging, perspiration, or micturition, is

often the means of warding off an otherwise fatal blow. The skin, the

bowels, and the kidneys, are severally to be acted upon as emergencies

demand: instance the specific operations of diet and medicines. The

color of the urine is altered by (to give a popular illustration)

_rhubarb_; its odor, by _turpentine_ (taken internally, or from an

inhalation of the vapor of them), and by the well-known vegetable

_asparagus_; and its composition by alkaline and other chymicals. The

function of cutaneous exhalation is augmented or diminished by warmth

or cold; and the action of the bowels is suspended or increased by

innumerable substances, forming portions of our daily food.

Analogous to these effects, is the result of certain conditions of

ill-health. A patient, laboring under fever or inflammation of any

important organ, will scarcely rid himself of a wineglassful of

blood-colored urine in the twenty-four hours; and there are many forms

of ailments, where the function of separating the urine from the blood,

or even the function of supplying the kidneys with that vital fluid,

are suspended, partially or entirely. Few of us have escaped attacks of

this kind; they are sure to follow long-pursued habits of dissipation,

or even occasional displays of it; and they are often the result

of accidents over which we have but little control. A patient will

complain of a frequent desire to make water; each effort so to do, will

be accompanied with excruciating pain. A small quantity, or a few drops

only, will dribble away, excoriating the passage as though vinegar was

passing over it, and putting on an appearance almost resembling muddy

port wine, or a thick solution or suspension of brick dust: there will

be present much fever and constitutional disturbance. The patient may

have shivering fits, pain round the loins, down the thighs, and over

the lower part of the abdomen. He will betray a readiness to submit to

anything, although conscious that his bladder is empty, notwithstanding

the violent and urgent efforts at straining, which he is continually

being called upon to make, as though his bladder were distended, and

ready to burst. On passing the catheter (I am supposing a severe case,

where retention of urine has at last occurred), not a drop will flow,

and the danger of the disease is thereby made apparent. Except very

severe measures be adopted, which it would be idle here to lay down,

the case is sure to terminate fatally. Instances are recorded, where

that event has been retarded upward of a week, during which time the

patient voided not one drop of urine.

The absolute cause of the disease is very obscure; but it has a

beginning, and to those only who suffer from a long-continued

diminution in this natural excretion, and who disregard it, is this

picture presented.

The treatment, in advanced stages of the disease, is strictly

professional; but the warning of the altered character of a customary

evacuation, should not for a moment be disregarded.

Suppression of urine is very different from retention: in the former,

there is none to excrete; in the latter, its escape is impeded. In the

chapter on stricture, the cause and manner of retention is explained,

and the mode of relief laid down, whereby the invalid himself has

a remedy at hand; but, in suppression, the resource is neither so

ready nor so effectual. It is, therefore, much wiser to notice the

first alteration, and to be prompt in seeking the nearest aid. Every

practitioner is acquainted with such. Although such are not ever

present, even in the most extensive practice, still they do occur; and

much as this mode of frightening a patient may be condemned, knowing

the frequently existing disinclination toward “laying up,” yet, if it

only induce a fellow-mortal to take the tenth instead of the eleventh

hour, one life may be saved, and the writer can well submit to the

disapproval and contempt of the thoughtless and indifferent.

THE GRAVEL.

UNDER the head of this disease may be classed all those urinary

affections, wherein a sandy deposite is observed, after the urine

has stood some time. This sandy excretion varies in its composition,

in the quantity voided, and in its continuance: and it is also often

separated, for it is held generally in solution in the urine as it

comes from the bladder, while in the bladder or in the kidneys; and

hence we find gravel in the kidneys, in the bladder, and in the

urine. Where it is precipitated, or formed in the kidneys or bladder,

it is apt to accumulate, and constitute what is called “Stone” in

those organs. As I have just observed, the composition of this gravel

differs, and differs also at different times in the same individual,

according to circumstances. Stones have been detected that, like the

rolling snowball, gather up, as they increase in size, whatever comes

in their way; and, accordingly, as the deposites are principally

composed of concretions, termed, in chymical phraseology, “Lithates”

and “Phosphates,” stones are frequently found to be formed, first of a

layer of one covering, then of another, and so on.

Gravel may exist for years without inducing much disturbance of

health, or it may produce serious inconvenience in a very short time.

The urine being acid, holds the salts which it contains in solution;

and, therefore, if the acid predominate, it becomes, through its own

excess, thrown down, when it is detected in the form of red sand; but

if there be an insufficiency of acid, the earths and salts of the

urine are thrown down, and they exhibit their existence in the form of

white gravel. Hence the two names “Red” and “White Gravel.” Acidulated

urine is looked upon as certainly indicative of health, and when in

excess, of a high tone of health; which, as the degree ascends, is

marked by inflammation and fever. Alkaline urine betokens feebleness of

constitution, or interrupted health. High living and an excited life

induce red gravel; irregular, or an impoverished living, with much

mental inquietude and physical exhaustion, establish white gravel.

The fact of gravel being known to exist without forming stone, is no

justification to suffer it to incur even the chance of such a finale.

There is no class of diseases so painful and distressing as those

wherein the function of the kidneys or bladder is interrupted, and the

majority of these affections are ushered in by a derangement of the

urinary fluid.

_Cause of Gravel._—The cause of gravel is owing to chymical affinities.

The urine, among its other constituents, contains _lithic acid_ and

_ammonia_, which two, in healthy urine, are combined and held in

solution. If any other acid, as may be instanced in expelled urine,

possessing a greater affinity for the _ammonia_ than the _lithic

acid_, be added, the _lithic_ will be thrown down. The same process

takes place when effected in the system, the source of which new acid

is the stomach, which, when in an irritable and feeble state, as in

indigestion, furnishes or abounds with muriatic acid. In like manner,

the urine containing salts, called phosphate of lime, ammonia, and

magnesia, on receiving an additional quantity of ammonia,[18] the

lime, for the less affinity to phosphoric acid than the ammonia,

is thrown down; and hence a salt, bearing its name, is generated,

either to be expelled like gravel, or to feed a nucleus already

existing in the bladder. These chymical changes are produced by the

causes before enumerated. We are subject to an infinitude of laws:

we are perpetually changing, and these changes may fairly be stated

as chymical affinities: it is owing to such, that the absorption of

fluids, and the deposition of substances, which exist more or less in

all derangements of health, ensue—to such, that we resist death, and

to such that we become its prey. Gravel is a disease not so productive

of fear or suffering, so long as it escapes when formed; but there are

so many circumstances that may give rise to the formation of stone,

that sandy urine should always command notice and treatment. A clot or

point of blood, that may have been discharged from irritation of the

kidney or bladder, is often found to form the nucleus of a stone: the

slightest substance, once in the bladder, is apt to form a basis for

accumulation: a pin, a fragment of a bougie, or any instrument, hair,

wood, and numberless other things that have found their way into the

bladder, have given rise to the formidable and distressing complaint of

stone.

_Treatment of Gravel._—It is not to be anticipated that every person

is prone to excrete gravelly urine, else certain dietetics, that

evidently give rise to the same in particular instances, had better

at once be removed from the list of articles of food, and their use

prohibited altogether; but there are instances where a constitutional

disposition exists in particular families, that is even transmitted

from generation to generation, to calculous diseases, and in those

cases, every precaution should be taken to avoid even their development.

The antidotes to the disposition to gravelly urine are, exercise,

temperance, and the adoption of all those means that tend to promote

a healthy action of the skin and kidneys, namely, the warm bath—it is

a perfect talisman in these affections—it needs but little eulogy;

the comfort and relief, where relief is sought, afforded on the first

experiment, best bespeak its praise. It is decidedly one of the most

useful adjunctive prophylactic measures we have.

I have already stated, that disorders of the urine arrange themselves

under two great heads—the acid and the alkaline prevalence. The

treatment is to neutralize the excess of either: the acid diathesis, as

it is called, is considered a less healthy deviation than the alkaline,

and is looked upon as indicative of greater constitutional break-up.

The medicines most in vogue in gravelly disorders are, turpentine (to

increase the formation of lithic acid), sulphuric, nitric, and muriatic

acids; while the antagonists to that form of the disease, wherein

the above are given, consist of ammonia, potass, and soda. The great

object, however, is to balance the health, to allay irritation, and

tranquillize the morbid uproar of the system. Here we have an extensive

field to select from in the class of sedatives. Opium, perhaps, is the

best—the most to be depended upon, its properties being best known; the

warm bath comes next; and lastly, the various tonics and astringents of

our pharmacopœia, of which quinine, uva ursi, pareira brava, achillæ

millefoliæ, buchu, &c., &c., stand foremost.

Although the lithic acid deposition is the most frequent, still, as the

disease advances, there is a strong tendency to the formation of the

alkaline; and as the remedies for the former are apt to accelerate the

latter disorder, it is most important that the urine should undergo

frequent examination to regulate the treatment. To recapitulate the

substance of this article, it may be stated, that gravel is a disease,

not dangerous in itself, but that it is always the forerunner, although

not always productive, of stone; stone being formed by the collection

and chymical union of the sand itself. This collection takes place

in the kidney, the ureters (the vessels that convey the urine to the

bladder), the bladder, and sometimes in the urethra. The stone so

formed varies in its composition and size, and is one of the saddest

ills that can befall human nature. Hence the importance of watching,

and attending to every urinary disturbance, of which gravel forms a

prominent feature, the treatment of which has been already stated; but

which, as it involves more practised judgment than a non-professional

invalid can be supposed to possess, had better be intrusted only to

professional hands.

THE END.

FORMULÆ

Form 1.

Four to six drachms of castor oil, the ordinary black draught,

a dose of salts, or a dose of Weir’s Compound Pills.

Form 2.

The following mixtures lessens the acrimony in making water,

abdues the irritability, and tends to diminish the discharge:—

Take of—

Carbonate of potass 1 drachm.

Nitrate of ditto 1 drachm.

Mucilage of acacia 5½ oz.

Hydrocyanic acid 10 drops.

Syrup of Tolu 2 drachms.

Mix. Take a tablespoonful in a wineglassful of water twice daily.

Form 3.

Take of—

Linseed tea ½ pint.

Spirits of Sweet Nitre 2 drachms.

Battley’s Sedative 60 drops.

Mix. Take three tablespoonfuls, twice or thrice daily.

Form 4.

Where it is inconvenient for a patient to carry a bottle about his

person, the following electuary, combining the essential ingredients of

the former two, may be substituted:—

Take of—

Lenitive electuary 2 oz.

Conserve of roses 2 oz.

Strong mucilage of acacia 2 oz.

Nitrate of potass 2 drachms.

Mix. Dose—Two teaspoonfuls twice or thrice a day.

Form 5.

A good combination, that may be taken even in the inflammatory stage.

Take of—

Cubebs 2 oz.

Carbonate of magnesia 1 drachm.

Mix. Dose—A dessert- or tablespoonful twice or thrice daily.

SPECIFIC REMEDIES.

Form 6.

Take of—

Balsam of copaiba 1 oz.

Powder of cubebs ½ oz.

Mucilage of acacia 6½ oz.

Spirits of sweet nitre 2 drachms.

Battley’s sedative 30 drops.

Or—

Hydrocyanic acid (Scheele’s strength) 8 drops.

Syrup of orange-peel 2 drachms.

Mix. Dose—Two tablespoonfuls, once or twice daily, in water.

Form 7.

_Turpentine Pills._

Take of Venice turpentine 1 drachm, form it into pills by adding as

much rhubarb as is necessary, and take two, three times a day.

Form 8.

_Turpentine Mixture._

Take of—

Venice turpentine 1 scruple.

Mucilage of gum arabic 2 oz.

Emulsion of bitter almonds 4 oz.

Syrup of orange-peel ½ oz.

Mix. Dose—Two tablespoonfuls three times a day. Sedatives may be

conjoined with the above preparations, if they produce too much action

of the bowels. To the pills may be added one scruple of Dover’s powder

to the drachm of turpentine. To the mixture, thirty drops of laudanum.

Form 9.

Take of—

Terebinthin chiœ 1 oz.

Extract of rhubarb 1½ drachms.

Camphor 1 drachm.

Mix and divide into pills of 5 grains each. Dose—Three, three times a

day.

Form 10.

Take of—

Cahio turpentine }

Balsam of copaiba } Of each, equal parts.

Oil of amber }

Mix, according to art. The turpentine must be dissolved by warmth. The

dose is 30 or 40 drops three or four times a day. This medicine is very

nauseous, but very serviceable in long standing gleets and obstinate

claps. The best way to remove the flavor left in the mouth after taking

turpentine, copaiba, and other filthy medicines, is to chew a piece

of gingerbread or cheese, or suck a lemon, or put some salt upon the

tongue.

Form 11.

_Injections to diminish the pain on making water._

Take of—

Rose-water 3 oz.

Solution of the acetate of morphine 2 drachms.

Mix.

Form 12.

Take of—

Goulard water 3 oz.

Mucilage 4 oz.

Solution of the acetate of morphine 2 drachms.

Mix.

Form 13.

_Sedative draught to be taken at bed-time when annoyed with chordee._

Take of—

Acetated liquor of ammonia ½ oz.

Camphor julep 1 oz.

Solution of the acetate of morphine 20 to 25 drops.

Mix.

Form 14.

Take of—

Dover’s powder 12 grains.

James’s powder 5 grains.

Mix.

Form 15.

Take of—

Compound camphor liniment ½ oz.

Laudanum ½ oz.

Mix, to form a liniment.

Form 16.

_Injection for the ulceration of the glans penis._

Take of—

Chloride of soda 1 oz.

Rose-water 5 oz.

Mix.

Form 17.

Take of—

Nitrate of silver 1 scruple.

Distilled water 1 oz.

Mix.

Form 18.

Take of—

Calomel ½ drachm.

Lime-water 4 oz.

Mix.

Form 19.

_Emetic Powder._

Take of—

Ipecacuanha powder 1 scruple.

Emetic tartar 1 grain.

Mix. To be taken in a glassful of warm water, and repeated in twenty

minutes, if it do not produce vomiting.

Form 20.

_Iodine._

Take of tincture of iodine twenty drops twice or thrice a

day in a little water.

Form 21.

Take of—

Hydriodate of potass ½ drachm.

Mucilage of acacia ½ oz.

Camphor julep 5½ oz.

Mix. Dose—three tablespoonfuls three times a day.

_The Sedative Application to anoint a Bougie with._

Form 22.

Take of—

Extract of Aconitine 1 grain.

Oil of Olives 1 drachm.

Mix.

Form 23.

Or take of—

Extract of Henbane 5 grains.

Lard or Olive Oil 1 drachm.

Mix.

Form 24.

Or take of—

Acetate of Morphine 3 grains.

Simple Cerate or Oil 2 drachms.

Mix.

_Stimulating Application._

Form 25.

Take of powder of calcined alum, and dust the end of a bougie

previously oiled, and introduce it to the stricture in the usual

manner, and suffer it to remain until the obstacle be overcome.

Occasionally the bougie may be smeared with the balsam copaiba,

where the case is chronic, and there happens to be much secretion

from the part.

Form 26.

Take of—

Iodide of potass 1 drachm.

Mercurial ointment 1 do.

Simple cerate 4 do.

Mix. A portion to be rubbed over the scrotum night and morning, as long

as it can be borne.

Form 27.

_Strong caustic solution of Dr. Doane._

Take of—

Caustic ⅓ drachm.

Distilled water 1 oz.

Mix.

Form 28.

_Wash for Chancres._

Take of—

The solution of chloride of soda 2 oz.

Rose-water 4 oz.

Mix.

Form 29.

_Black wash for Chancres._

Take of—

Calomel 1 scruple.

Lime-water 3 ounces.

Mix.

Form 30.

_Red wash for Chancres._

Take of—

Bi-chloride of mercury 4 grains.

Lime-water 4 oz.

Mix.

Or, Form 31.

_Blue wash for Chancres._

Take of—

Sulphate of copper 5 grains.

Distilled water 1 oz.

Mix and strain.

For dressing chancres, lotions and washes generally answer better

than ointments; but their alternate use is sometimes serviceable.

In cracked sores near the prepuce, the blue ointment has wrought

a cure when all the lotions devised were ineffectual.

Form 32.

Take of—

Red precipitate of mercury 4 grains.

Ointment of spermaceti 1 oz.

Mix.—A little to be smeared over the ulcer, twice a day.

Form 33.

_Active aperient in indolent Chancres._

Take of—

Calomel 4 grains.

Powder of jalap 15 to 20 grains.

Mix.—To be taken in something thick, as jelly, honey, or tamarinds.

Form 34.

_Active aperient, to be mixed in water and (stirring it) to be drank

off quickly._

Take of—

Chloride of mercury, or calomel 5 grains.

Powder of jalap 25 grains.

Mix.

Form 35.

_Ointment to promote absorption of Bubo._

Take of—

Iodine of potassium 1 drachm.

Tincture of iodine 1 drachm.

Acetate of morphine 10 grains.

Mix.—Apply constantly a plaister of some of this ointment spread upon

rag or lint, over the bubo, and occasionally rub a little of it gently

into the skin.—_Doane._

Or, Form 36.

Take of blue ointment a similar quantity, and use it in like manner to

the preceding. The reliance to be placed on this ointment is precisely

the same as the other, namely, to excite absorption. The following

ointment may also be used for the same purpose.

Form 37.

Take of—

Calomel 2 drachms.

Simple ointment 6 drachms.

Mix.

Form 38.

_Stimulating ointments to promote the healing of indolent ulcerated

Buboes._

Take of—

Red precipitate of mercury 5 grains.

Ointment of spermaceti 1 oz.

Mix.—The ulcer to be dressed with a small portion of this ointment

spread upon lint. Or the following, which is stronger:—

Form 39.

Take of—

Red precipitate of mercury 5 grains.

Yellow basilicon 2 drachms.

Ointment of spermaceti 6 drachms.

Mix.—To be used like the preceding.

Or, Form 40.

Take of nitrated ointment of mercury, diluted with an equal proportion

of simple ointment.

Or, the unadulterated strong mercurial ointment.

Form 41.

_Styptic application for indolent Ulcers._

Take of—

Caustic ½ drachm.

Or, Sulphate of copper ½ do.

Distilled water 1 oz.

Mix and strain, and smear the surface of the sore with a hair pencil,

impregnated with either of the solutions: simple or astringent

dressings may be applied afterward.

Form 42.

Take of—

Chloride of soda 2 ounces.

Rose-water 2 do.

Mix.

Form 43.

_Preparation of Iron._

Take two drachms of carbonate of iron three times a day, gradually

increasing the dose to half an ounce, or even an ounce; the bowels

during the taking of this medicine should be kept open.

Form 44.

_The following is an excellent combination._

Take of compound iron pill two drachms, to be divided into 24 pills—two

to be taken three times a day.

Form 45.

_Quinine._

Take three grains of sulphate of quinine three times a day. Or,

Form 46.

Take of—

Compound tincture of bark 2 ounces.

Sulphate of quinine 12 grains.

Muriatic acid 20 drops.

Mix.—Dose, a teaspoonful three times a day, in water.

Form 47.

_Strengthening Pills._

Take of—

Ioduret of iron ½ drachm.

Castile soap ½ do.

Alkaline extract of gentian 1 do.

Mix.—To form 30 pills—take one twice daily.

Form 48.

_Tonic and Alterative Mixture._

Take of—

Oxymuriate of mercury 2 grains.

Muriatic acid 60 drops.

Tincture of bark 2 oz.

Mix.—A teaspoonful to be taken twice or three times a day in a little

water.

These drops are highly serviceable to persons of weak constitutions,

whom it is desirable to place under the influence of mercury. They

form the basis of most of the advertised anti-scorbutic drops of the

patent medicine venders.

Form 49.

_Compound decoction of Sarsaparilla._

Take of—

Sarsaparilla root, sliced 4 ounces.

Boiling water 4 pints.

Macerate for four hours in a vessel lightly covered, and placed

near the fire; then take out the sarsaparilla and bruise it; return

it again to the liquor, and macerate in a similar manner for two

hours; boil it down to two pints, strain it, and then add—

Sassafras root, sliced ¼ ounce.

Guaiacum root, rasped ¼ do.

Liquorice root, bruised ¼ do.

Bark of mezeroon root 1½ drachm.

Boil the whole together for a quarter of an hour, and strain.

Dose, from a quarter to half a pint, three times a day.

To avoid the tediousness of daily preparing the above, many

manufacturing chemists evaporate a large quantity, and preserve

the extract, which retains all the virtues of the decoction, and

is at all times ready for immediate use. Or,

Form 50.

Take of—

Bruised root of Jamaica sarsaparilla 4 ounces.

Liquorice root, sliced ½ ounce.

Lime-water 1 quart.

Macerate for 24 hours in a dark and cool place—strain and bottle it,

and take a pint daily in divided doses. This is a very superior form

of administering sarsaparilla. Or,

Form 51.

Take of—

Oxymuriate of mercury 2 grains.

Muriatic acid 5 drops.

Compound extract of sarsaparilla 2 oz.

Dissolve the same in one quart of water, and take a wineglassful twice

a day.

Form 52.

_The Iodide of Potass Mixture._

Take of—

Iodide of potassium 1 drachm.

Iodine 2 grains.

Mucilage of acacia 3 ounces.

Hydrocyanic acid 12 drops.

Pure water 5 ounces.

White sugar ½ ounce.

Mix. Take a dessert- or tablespoonful twice or thrice daily in a

wineglassful of water.

Form 53.

Take of—

Iodide of potassium 1 drachm.

Acetate of morphine 10 grains.

Spermaceti ointment 1 oz.

Mix. Rub a portion, the size of a nut, over the affected part night and

morning. If much irritation be produced, it must be disused for a time.

Forms 54, 55, 56, 57 see pages 126–128.

Form 58.

Take of—

Sarsaparilla sliced 1 oz.

China root 1 oz.

Dry rind of 20 walnuts.

Antimony 2 oz.

Pumice stone 1 oz.

(Tied in separate bags, and boiled with the other ingredients.)

Distilled water 10 pints.

Boil to one half, and strain.

Dose—An aleglassful twice or thrice daily.

Forms 59, 60, 61, 62 see page 132.

The best aperient for females is certainly a combination of castor

oil. The following form is a very good one:—

Form 63.

Take of—

Castor oil 1 oz.

Mucilage of acacia 2 oz.

Spirits of sweet nitre 1 drachm.

Syrup of orange-peel ½ oz.

Water 1 oz.

Mix. Take half for a dose.

Forms 64, 65, 66, 67, 68, 69, 70 see pages 156–158.

Forms 71, 72, 73, 74, 75, 76, 77, 78, 79 see pages 158–161.

FOOTNOTES

[1] A wash composed of one part of the chloride of soda, with five

of water, is as good as can be used; the same may be injected up the

urethra.

[2] Lining internal structures which have no outlet, as that in the

abdomen, called the peritoneal.

[3] To enter into a description of the pathological condition of

the bladder in the several states of irritability, paralysis, and

inflammation, would be to swell this article to an inordinate length,

and serve no useful purpose—the symptoms and treatment comprising the

most essential knowledge for the patient to possess. It may be briefly

stated, that the bladder is less subject to become disorganized (the

function being chiefly the disordered symptom), and sooner even regains

its tone than other organs not less important to life.

[4] Colles, Wallace, Ricord, of the Venereal hospital, Paris.

[5] _Mercury._

The preparations of mercury are various: but those chiefly employed

in the treatment of syphilis are the oxymuriate, or bi-chloride,

the submuriate, or chloride, the red precipitate, or the hydrargyri

nitrico-oxydum, the blue pill, the red sulphate for fumigations, and

the blue ointment.

Ptyalism or salivation, which implies an extraordinary secretion of

the salivary and other glands, occasioned by the taking of mercury,

inasmuch that when carried to an unwarrantable extent, ulceration is

the consequence, may be produced by the internal exhibition or external

application of almost any of its preparations. With this view, however,

the blue pill is usually administered in doses of five grains twice a

day, or the blue ointment is directed to be rubbed in on the inner part

of the legs and thighs, in quantities varying from one to two drachms

night and morning. Mercury, when given to excite ptyalism, is generally

taken in conjunction with sarsaparilla (see Form 51, or the fluid

extract). The symptoms whereby the effects of mercury are ascertained,

are a coppery taste in the mouth, followed by a tenderness of the gums

on mastication, an increased flow of the saliva, and a peculiar fœtor

of the breath. It is usual, on the tainted taste being perceptible, to

diminish or discontinue the further use of the medicine, unless the

case be very severe, or merely to keep up the effect produced. But it

can not be denied that, although sufficiently manageable in scientific

hands, mercury, or any one of its preparations, is too powerful to be

taken indiscriminately.

[6] _Antimony._

The preparations of antimony consist of the precipitated sulphuret,

called now the oxysulphuret of antimony, and the powder, as directed to

be made in the Pharmacopœia, or its secret modification, known by the

name of “Dr. James’s Powder.” The sulphuret enters into the composition

of the red or Plummer’s pills, which is an admirable alterative, given

in conjunction with sarsaparilla, in doses of five grains, once or

twice a day. The James’s powder, with the like intention, may be taken

in two or three grain doses twice or thrice a day.

[7] Wagner, translated by Dr. Willis.

[8] Some say eight days after.

[9] Instances of different conceptions following connexion at brief

intervals are of occasional occurrence.

A case is recorded of a negress having brought forth a negro and a

mulatto child, and who confessed having received the embraces of a

white and a negro the same evening. Drs. Dewees of Philadelphia, and

Francis of New York, adduce similar instances.

[10] The membrane containing the liquid comes away with the after-birth

or placenta; but when it is brought away with the child’s head, it is

named a “caul,” to which the ignorant attach a superstitious belief

that it saves the possessor from drowning, and hence it has been a

source of traffic between the cunning and the weak-minded. Cauls are

made by detaching the membrane from the placenta.

[11] Yellow wax may be substituted for the white wax, which renders

the ointment stronger and better adapted for excoriations that yield a

discharge.

[12] Every nurse is acquainted with the usefulness of starch, tutty

powder, Fuller’s earth, &c.

[13] Blundell.

[14] Dr. A. Sidney Doane has recorded a case, in his edition of

“Good’s Study of Medicine,” where a woman brought forth fifty-seven

children.—Vol. ii., p. 503.

[15] A patient was admitted into the ophthalmic wards of the Hotel

Dieu, Paris, with great weakness of sight, amounting almost to

amaurosis. He confessed that he was in the habit of polluting himself,

and that he was immediately seized with complete blindness whenever he

addicted himself to the practice. Cases very similar to the above have

been noticed by Dr. Doane, of New York, who has paid great attention to

diseases of this character.

[16] The convertibility of India-rubber to so many useful purposes

has not escaped the attention of surgeons, and it is found to be

an excellent material for trusses, pessaries, bougies, &c., and

consequently much used for them. I find them in my own practice

far preferable to metallic or any other description. Many cases of

hæmorrhoids, as well as of prolapsus, that have been given up as

incurable, on account of the parties objecting to wear metallic

instruments, or submit to the operation of excision or ligature,

have speedily yielded to the application of the same manufactured of

India-rubber; indeed, every day’s experience so convinces me of their

superiority and efficacy as a remedy in these disorders, that a patient

afflicted with the most formidable form of either disease need not

despair of a prompt and certain recovery.

[17] The specific gravity of the urine materially depends upon those

causes which act diuretically, and upon the quantity of fluids

swallowed, which, if taken in excess, of course increases the watery

portion of the urine, and vice versa. The density of the urine is

ascertained by an instrument called an “Hydrometer,” which, upon being

immersed in the urine, indicates its specific gravity. The usual

specific gravity of healthy human urine varies from 1.010 to 1.015,

while the temperature ranges from 75 degrees of Fahrenheit to 120. The

quantity averages from two to three pints per diem, but depends not

only upon the quantity of fluids consumed, but also upon the nature

of the food, vegetables generating more urine than animal substances.

In infancy and old age, the temperature of the urine is below this

standard, but nearly equivalent to each other; whereas it is only at

the period of puberty that the temperature noted exists.

[18] Furnished in the system by the decomposition of urea.

—————————————————— End of Book ——————————————————

Transcriber’s Note (continued)

Obvious punctuation errors in the transcribed text have been repaired.

Variations in spelling are common in this book. In the case of medical

terms in which the ligatures ‘æ’ and ‘œ’ could be used, the variations

are numerous and noticeable. Thus we find the terms “hemorrhage”,

“hæmorrhage” and “hœmorrhage” being used interchangeably. Similarly for

“hæmorrhoids” and “hœmorrhoids” and all the words derived from the

foregoing terms.

Except as noted below, unusual or variable spelling and hyphenation as

published in the original book have been retained.

Page 11 — “membraneous” changed to “membranous” (diminishes at the

membranous portion)

Page 16 — “then,” changed to “them” (that connects them together)

Page 21 — “developes” changed to “develops” (the sooner develops the

disease)

Page 22 — “ay” changed to “any” (to resist any efforts)

Page 24 — “arm-pits” changed to “armpits” (under the armpits)

Page 29 — “gonorrhæa” changed to “gonorrhœa” (in curing gonorrhœa;)

Page 30 — “head-ache” changed to “headache” (inclination to headache)

Page 50 — “surfacial” changed to “surficial” (surficial and muscular

membranes)

Page 54 — “fœces” changed to “fæces” (the fœces pass in small

quantities)

Page 58 — “permaneut” changed to “permanent” (permanent irritability of

the bladder)

Page 62 — “now” changed to “how” (to show how imperative it is)

Page 80 — “coherd” changed to “cohered” (where numbers cohered together)

Page 85 — “empyrical” changed to “empirical” (by the most empyrical

measures)

Page 87 — “chancerous” changed to “chancrous” (a chancrous sore)

Page 89 — “accompanying” changed to “above” (Witness the above

wood-cut.)

Page 102 — “incrustrations” changed to “incrustations” (similar

incrustations are formed)

Page 107 — “desquemated” changed to “desquamated” (the pimple has

broken or desquamated)

Page 109 — “raced” changed to “traced” (to such weknesses may be traced

the relapses)

Page 118 — “desquemate” changed to “desquamate” (exfoliate, or scurf,

or desquamate)

Page 125 — “are are” changed to “are” (There are also deep and painful

fissures)

Page 131 — “pecuiar” changed to “peculiar” (a peculiar contour of the

countenance)

Page 134 — “triflind” changed to “trifling” (trifling errors in diet)

Page 137 — “unimpergnated” changed to “unimpregnated” (when

unimpregnated, is very compact)

Page 146 — “corpulant” changed to “corpulent” (like a very corpulent

man)

Page 149 — “ipresses” changed to “impresses” (the womb impresses upon

the bladder)

Page 167 — “Henry III.” changed to “Henry II.” (Henry II. consulted

one Fernal for the infertility of his queen, Catherine de

Medicis)

Page 196 — “protusion” changed to “protrusion” (extraordinary

protrusion of piles)

Page 200 — “bladders” changed to “bladder” (into the bladder whence it

is voided)

Page 214 — “pharmacopœa” changed to “pharmacopœia” (of our pharmacopœia)

In anatomical references, the book uses “chord” throughout in place of

“cord” — see for example “umbilical chord” and “spermatic chord”.

There are seventy-nine treatment recipes/formulæ (“Forms”) in the

book. All are printed in a similar style. However fifty-five appear as

footnotes while the rest appear in page text. For ease of reference in

the transcription, all the footnoted Forms have been gathered together

and moved to a new FORMULÆ annex at the end of the book. Minor changes

to the page text consequent on the new arrangement are as follows:

Page 31 — “[See annexed Formulæ 2, 3, 4, 5.]” changed to “[See Forms

2, 3, 4, 5 in Formulæ annex.]”

Page 33 — “Subjoined are” changed to “See Formulæ annex for”

Page 34 — “(see note)” changed to “(see Formulæ annex)”

While the original style and content of the seventy-nine Forms has

been carefully preserved, minor corrections to the layout of some have

been made so that all are displayed to the reader in a consistent

format. This avoids small but distracting variations on a page that

look like errors in transcription. For the same reason, variations in

the spelling of dosage measures in the Forms have been regularised.

Thus “table spoonful”, “table-spoonful” and “tablespoonful” all appear

as “tablespoonful”. Similarly for “teaspoonful” and “wineglassful”.

Plural forms have been changed in the same way. For consistency, the

regularising of these words has also been applied to their appearance

elsewhere in the body text.

Ordinary footnotes have been re-indexed using numbers and moved to a

FOOTNOTES section placed after the FORMULÆ annex.