OBSERVATIONS on the effects of HEMORRHAGE and some other REMEDIES in the cure of GONORRHOEA; communicated to Dr. MILLER by Dr. SAMUEL AKERLY, one of the Physicians of the Dispensary, in the city of New-York. DEAR SIR, Our late conversation on the subject of Gonorrhea has induced me to offer you some further observations on the cure of this disease, in addition to the following case which I then promised you. It occurred during my residence at the New-York Hospital, as House Physician. This case of Philip Lee, affected with Gonorrhoea, was a most distressing one, and a case in which a remarkably speedy cure was effected. Lee was once in the Hospital as a surgical patient for nearly a year with syphilis. He had been discharged about five months, and returned on the 28th July, 1806, with a recent gonorrhoea. It being contrary to the rules of the hospital to receive a patient a second time with a venereal complaint, he would have been rejected had not his case been desperate. He applied to be received on the afternoon of the fourth day after he observed the symptoms of clap.His penis was much swelled, and for the last twelve hours he had passed no urine, but in straining he had burst a bloodvessel which had bled all day from the urethra. A strong solution of alum was given as an injection, to stop the hemorrhage. The following diuretic mixture was also prescribed. R Sp. Nitr. Dulcis zij Aq. puræ zvj Carb. Sod. 3ii m. Capiat ager 3ss omni horâ, vel sæpius pro re nata. With this, the patient passed a very restless night without sleep and with a continuance of the hemorrhage; not having used the injection till I was awakened past midnight and procured him a syringe. In the course of the next day, by frequent injection he stopped the hemorrhage, but was very uneasy from the distention of the bladder, still passing no urine. I therefore ordered him a common clyster which evacuated the rectum, and gave him considerable relief. I postponed introducing the catheter as long as possible (fearing at that time, though perhaps my fears were unnecessary,) lest the matter of gonorr hea should be carried into the bladder. At night however of the second day, I drew off upwards of a quart of bloody urine, which afforded him instant relief. On the third day he passed urine freely, which gradually lost its bloody colour. He continued his medicines till the 31st, when his urine passed very free and clear, and without pain, the swelling of the penis being likewise abated. The injection of alum (sulphate of alumine) was continued till the 4th of August, when having recovered from his alarm, and having no pain uneasiness or running, he went away well, eight days from the time he was received. In this instance, the local bleeding was of great service, and might have cured the disease itself, after a passage was found for the urine. This case may be placed with those related by Dr. Pascalis in the Med. Repos. vol. 8. p. 35. From the repeated recurrence of similar cases, terminating in a cure, I am induced to believe that my patient would have recovered from the gonorrhea without the aid of the prescribed medicines; but my situation made some prescription necessary in order to avoid unpleasant imputations. From the frequency of this form of venereal infection, and the disagreeable symptoms often remaining after the present mode of treatment, there is no disease which produces so much anxiety of mind in the patient, and consequent trouble to the physician. The most unhappy and most common terminations are a stricture, or long continued gleet. The treatment of gonorrhea is so much neglected, that druggists' apprentices, and students of medicine, have the most patients, and physicians are seldom or ever consulted except (as in vulgar though expressive language) for the after-clap. The afterclap, if it should be stricture, is worse than the primary disease. Nothing is more common with practitioners than to induce one disease to cure another, as in a salivation and the application of blisters, which are easily cured; but the stricture is worse to cure than the gonorrhea itself. I am not led to the same inferences as Dr. Pascalis in considering the case related by himself, and the preceding one. He speaks of the venereal disease, including syphilis and gonorrhea. I speak of gonorrhea independent of syphilis, as a disease sui generis, having its particular symptoms, and method of cure; a venereal complaint contracted in coitu, in the same way as syphilis, but a disease as different in itself as typhus is from the plague. I do not mention this for the sake of controversy. I am aware that there is good authority for believing that some cases of gonorrhea will not yield without the aid of mercury, which fact is relied on for their identity; but such facts are not constant nor frequent; on the contrary, many cases have occurred to myself and Dr. Beekman (my former colleague at the Hospital and present colleague in the Dispensary), in which the syphilitic symptoms were entirely subdued and an accompanying gonorrhea left, after a complete salivation. Many patients also, salivated by desire for the clap, have recovered from the salivation with the disease as virulent as ever. With the exhibition of mercury, I have used the fashionable injections, the sulphate of zinc, the acetate of lead, &c. and thus found to my conviction that gonorrhea is not so easily cured as may be wished. When the preceding case occurred to me, I wrote down the facts, and turned to those related in the Med. Rep. but laid by the papers for future consideration. I am glad to accord so well with you in opinion, as to think that we must look for the cure of gonorrhea in learning the best treatment of topical inflammation. The case thus before you illustrates this opinion. It need hardly be observed that the membranous surface of the urethra is the seat of gonorrhea. When the poison of gonorrhea is applied to this surface, inflammation is excited and a morbid increased secretion takes place, without a destruction of the part affected. When this happens "The cure consists (as Dr. Adams observes*) in restoring the secretion to its natural quality and quantity." The diseases produced by the morbid poisons of Variola, Vaccina, Rubeola, &c. will cease spontaneously and within a given time. We have also sufficient proofs that virulent gonorrhoea will cease spontaneously; but nature seems to have set no bounds to the termination of this disease; hence a sudden check may be put to its progress without injury.— This check must be looked for in the treatment of inflammation. Of the methods of subduing inflammation we shall hereafter speak. The various injections that are used in the cure of this disease are generally given with the idea of a specific cure. That few or none of them act in this way, may be seen by the different qualities of the substances employed, all of which at times succeed. The metallic salts when used by injection are intended to correct the disease by producing a * Adams on morbid poisons. London, 1807. greater irritation; but where the inflammation is high they are dangerous. These injections do, to be sure, cure the disease in many instances, but in many more they leave the part in a state of chronic inflammation with the morbid secretion altered in quality but not in quantity. The disease then continues in the form of gleet, and is no longer a morbid poison though a morbid secretion. Thus indeed the patient is relieved from the most painful symptoms of the disease, but not from the trouble, inconvenience, and solicitude, which continue till the discharge ceases; and not then if the thickening of the membrane of the urethra has produced stric ture. The practice of curing gonorrhoea by alkalies, was introduced into the New-York Hospital, by Dr. Mitchill. It has in a number of cases effected a cure, and will again. I cannot say that the cure will be speedy. It was begun with the idea of correcting the morbid poison by an alkali, supposing that it would be an antidote to the poison which might thus become neutralized.* If this be the effect on the poison of gonorrhea, the solution of sulphate of soda, as used by Dr. Andrew Ferguson,† must operate in a like manner by the chemical attraction being greater between the soda and poison, than between the sulphuric acid and soda. That this is the case however I am not satisfied. But it is certainly the neatest and cleanest way, to cure chancres with alkaline dressings, while the system is undergoing the mercurial action. With the topical use of alkalies, we shall never have buboes from chancres, as in using lunar caustic. The common language of physicians in the cure of gonorrhea is that of timidity, anticipating some violence to the constitution by a sudden check to the disease; whereas, if we attempt improvement by following the method of nature as in the case related, it may be cut short at any period by the proper treatment. This method however may be difficult to pursue, as we have not the means exactly to imitate nature. The means then pointed out for the more speedy termination of this disease, are, bleeding and cupping in the neigh bourhood of the parts affected, leeches applied to the penis, blisters, and cold in its various modes of use. * Med. Repos. vol. 3, p. 302. † Med. Museum, vol. 1. p. 462. I am now proceeding in an experimental enquiry, whether alkalies, when mixed with vaccine infection, will not neutralize its virus. These hints are suggested by the case above related, and offered to your consideration. The application of leeches and cold, would perhaps be the most adviseable. Even very cold injections might be effectual; but on the further consideration of these points, I defer more particular enquiry till some practical experience is obtained. On the external application of cold water, however, I recollect the case of Mr. A- who was materially and almost exclusively benefited in a Gonorrhea by the local affusion of cold water several times a day, as he feared the use of injections. I defer entering now, as I intended, into the subject of inflammation, it being so important as to require more minute attention than could be bestowed upon it in a short communication. Accept assurances of my respect and esteem. DR. EDWARD MILLER. Remarks on the MANNERS of the INDIANS, living high up the Missouri: Translated from a manuscript of JEAN BAPTISTE TRUDEAU, put into the possession of Dr. Mitchill, by Mr. NICHOLAS BOILVIN. (Concluded from p. 56.) Although I have said that the savages live without law or subordination, I do not intend to be understood as affirming that they have no manner of regulations, no police nor any established customs among them, for the preservation of order in their nation. All I mean to represent, is, that they have no despot, or absolute government. Every tribe has its chiefs and respectables. These, added to the old men, compose the council, in which their public measures are considered and determined. After the question is carried in the affirmative or negative, an orator proclaims the result throughout the village, and every one submits to the decision. When the inhabitants of an entire village march on an expedition to hunt bisons, the council appoints a certain number of the bravest young men as soldiers and guards. chiefs and old men regulate the distance of the encampments on the route, define the limits within which hunting shall be performed from day to day, and make known to all the hunters that they must not transgress the prescribed bounds. If after these arrangements any one, through ambition or en The |