two days, of the discharge, on the very first appearance of the yellow matter, and before much redness and inflammation have been set up, as then it would only aggravate the disease. After the twelve injections have been used, cubebs or copaiba should be taken for a few days, in the doses hereafter to be mentioned, all sexual intercourse and spirituous liquors avoided, and in a fortnight the patient may resume his usual habits. It is no easy matter to nip in the bud an incipient gonorrhoea, and unless all these directions be carried out, the complaint will probably return in a day or two (for it has as many heads as the hydra), and may then last for months. This treatment is without any risk of causing stricture or other evils; which, by cutting short the disease, it rather tends powerfully to prevent.

Instead of using injections, copaiba or cubebs alone will very often succeed in checking the disease at its outset. They should be given the moment the first drop of yellow matter is perceived, and should be used in rather larger doses than those adapted for the later stages, as the object is to cut the disease short at once by vigorous means. Thus two or three drachms of cubebs should be taken thrice a day. M. Ricord says, that this abortive treatment is more likely to succeed, where there is little or no pain or scalding, in the commencement of the disease; and also that even although it fail in wholly arresting the discharge, it never fails to modify and mitigate the symptoms, so that by persisting in remedial measures, the disease is generally brought to a close in from fifteen to twenty days. He says, moreover, that much harm is often done by a popular prejudice against trying speedily to arrest the discharge; whereas his object always is, to cure the disease as quickly as is consistent with caution in the use of the remedies; for, he says, the danger of a gonorrhoa depends upon two things; first, the severity to which the inflammation is suffered to attain, and secondly, its duration.

But if the golden moment have been allowed to pass, or if the abortive treatment have failed; if the symptoms have gradually increased in severity, and there be present much scalding in making water, with heat, redness, and swelling at the orifice of the urethra, the abortive treatment can no longer be applied, as it would exasperate the inflammation. Antiphlogistic (or anti-inflammatory) treatment should now be used. The patient should take plenty of mucilaginous drinks, as barley-water, syrup and water, or plain cold water, to render the urine as little irritating as possible. He shonld rest on a sofa, and have low diet. A general warm bath every night for from a half to one hour is an excellent means of quieting the inflammation. Local warm baths are not so good, as they tend to congest the part. Leeches may be applied to the perineum (the space between the scrotum or pouch of the testicles and the anus or opening of the intestine,) but not to the loose skin of the penis itself, as in that situation their bites may be followed by erysipelas. Some authors recommend cubebs and copaiba in this acute stage, but Ricord does not approve of them; for he says, they often do more harm than good, when the inflammation runs high, and, besides, lose the virtues they would have had, in a later stage. The bowels should be freed by

purgatives, which cool the system, and so subdue the inflammation; and, if it run high, tartar emetic should be given.

This medicine is the most powerful means of subduing active inflammation in almost all parts of the body; except where, from the nature of the organs inflamed, it cannot be given, as in inflammation of the stomach or bowels. If given in sufficient doses, it brings on a state of extreme sickness, which, as can readily be understood, is the most powerful opponent of inflammation. This invaluable medicine, whose general adoption now. a-days in inflammatory diseases has superseded in very many cases the use of the lancet (which, by its expenditure of the vital fluid, is a remedy never to be resorted to, if safer means can be found), may be given in doses of from one-fourth to one-half a grain, in an ounce or two of water, every two hours, according to the quantity found requisite in each case to cause the state of nausea.

The chordee, which will be more severe in proportion to the violence of the inflammation, and also to the depth it has reached in the canal, should be treated by avoiding everything that could excite erections. These are generally caused by the warmth of bed; therefore a hard mattrass and light bed-clothes should be used. M. Ricord praises camphor very highly as a sedative in chordee, and gives it either in pills with opium-namely, six grains of camphor, and one grain of opium, made into two pills, to be taken at bed-time; or ten grains of camphor, one of opium, the yolk of an egg, and four ounces of water, given in an ejection, an hour before going to bed.

By these antiphlogistic means, the intensity of the gonorrhoeal inflammation, will probably be subdued, and the scalding, heat, and other signs of acute inflammation diminished, although the yellow purulent discharge still continues copious. The patient should now begin to take some of those remedies which have a specific action, and most powerful control over gonorrhoea-namely, cubebs or copaiba. These are both remedies of very great value, and in the great majority of cases succeed in curing the complaint, if skilfully used. Sometimes the very first doses will reduce the discharge to a single drop in the morning. Copaiba is a kind of resinous balsam, with a taste which to many is exceedingly nauseous; and so it has been ingeniously enclosed in little gelatinous capsules (the capsules de Mothes) that are equally efficacious with the plain balsam; which may itself be taken in water, or suspended in a mucilaginous liquid. Cubebs -a hot pepper-like powder, containing as its active ingredient a volatile oil, very similar to that which is the active principle of copaiba (both of which volatile oils may be taken pure, and are thus equally efficacious, and not so apt to disagree)—may be used in the following formula, which is exceedingly effective, and in some constitutions succeeds much better than copaiba. Take two or three ounces of cubebs, and make them into a paste with honey. Begin with three tea-spoonsful the first day, and increase the dose taken on the following days to five or six tea-spoonsful, drinking at the same time plentifully of barley-water, milk of almonds, or other mucilaginous drink, so as to prevent the cubebs from irritating the stomach or kidneys. The medicine acts equally well if taken merely ju water, in similar doses.

These medicines should not be given up as soon as the gonorrhoea has ceased, for, if so, it would most probably re-appear; but they should be continued for a few days longer, in gradually diminishing doses. Some constitutions are most benefited by one, others by the other; so that if the one do not succeed, we may have recourse to its fellow.

But we cannot expect to find such a thing as an unalloyed blessing, and thus there are evils, which in some cases arise from the use of these medicines. Among them is a rash, which they sometimes bring out over the body, attended with smart fever, and arrest of the gonorrhoea; which however returns when the rash disappears. It seems to be owing to a disordered stomach, and to exposure to cold and damp, which should be carefully avoided, while taking the medicines. Copaiba also sometimes causes nausea, diarrhoea, and griping, which, when slight, need not be attended to, except by avoiding cold, damp feet, &c. Cubebs has in some few cases, when given in too large doses, caused symptoms of inflammation of the stomach, which occurrence must be guarded against by ceasing at once the medicine, if any incipient signs be perceived.

Cubebs are also often adulterated, and may thus prove injurious, and should, as well as many other medicines, be got at the best druggists. All medicines are to be viewed as double-edged weapons, in themselves most important causes of disease, and being so, we should desire to use them as rarely as possible.

At the same time that these internal remedies are used, Ricord employs, whenever the inflammation has been sufficiently subdued, a local treatment also, as the conjunction of both is much more certain. Injections of nitrate of silver, of the strength before recommended-namely one fourth of a grain to the ounce of distilled water, should be employed as before directed, viz, twelve in the forty-eight hours, when they may be stopped, and the internal remedies continued. In some old standing cases, when the mucous membrane has become relaxed and thickened, this injection may not be sufficiently strong to produce the reddish discharge and other signs of salutary action; and, if so, it may be increased to from one to two grains, to the ounce of water.

There are different forms of the chronic stage of gonorrhoea, whose treatment I have been describing. In some cases the yellow discharge continues as thick and copious as in the acute stage, although the scalding in making water is in great part, or altogether, absent. In others the discharge is reduced to what is called a gleet, in which it has lost its yellow colour, and has become nearly colourless, like gum. or small shreds of vermicelli; in other cases no discharge is visible during the day, and only a drop or two, gluing together the orifice in the mornings, remains.

These gleets, though some persons care little for them, are to others a source of great annoyance, in proportion to the susceptibility of their nature, moral and physical; and they often, by their long continuance, and by inducing stricture, or, as we have seen above, spermatorrhea, bring the patient into a state of the most miserable hypochondria.

Some cases of chronic gonorrhoea, or gleet, are exceedingly obstinate, and resist all sorts of treatment, causing endless annoyance and im

patience in those affected with them. Thus they often last for months, and not unfrequently from one to two or three years; and Ricord mentions one which lasted thirty years; so that it is of immense, importance that, by a vigorous and well directed treatment at first, the risk of such consequences should be prevented. A gonorrhoea is not a complaint to be trifled with; in some constitutions it is exceedingly difficult to subdue, whether from their weakness, incapability of bearing the remedies, unhealthy relaxing life of confinement, neglect, want of self-restraint in applying for, a sufficient time the remedies, or abstaining from drinking, and other sensual enjoyments; and perhaps above all, from the unfortunate and pernicious social feelings on the subject of this disease, which cause it to be concealed, prevent the sufferer from applying for assistance in time, hamper and obstruct all the remedies employed, and too often reduce the patient and the humane physician to despair of the

cure.

There is no matter perhaps in which concealment does more harm to mankind, than in this of genital and venereal diseases. The grand point ever to be kept in view, in remedying diseases, is, that they be treated as early as possible. Not a moment should be lost, on the first appearance of any disease, in taking measures to arrest it; for the first few golden moments are often the most important of all. Now, the miserable shame and fear attending on venereal and genital complaints, in almost all cases, prevent the inexperienced youth, and still more the woman, from applying for relief, till the irrevocable time is past; till the mischief is fully developed, and the disease riots and revels in its strength, exulting at our impotence to arrest it, and proceeding to bring on consequences which no man can answer for, and which may be most disastrous. Must we not then consider the odium attaching to venereal diseases, as being most sinful in every individual who entertains it, since it is the cause of so many miseries to man and woman?

If a gleet have lasted a long time, we should try to make out, in each separate case, the cause of this chronicity. And first, the canal should be explored with a bougie, to see whether there be not a stricture, which is a frequent cause of lingering gleet. Sometimes, when the inflammation lingers deep in the canal, at the orifices of the ejaculatory ducts, there are frequent seminal emissions in the night, which aggravate in their turn the gleet, and frequently are the cause of bringing back a gonorrhoea, which was on the wane. From this exhausting complication, all the horrors of spermatorrhoea may in time be established. In such cases slight cauterization of the walls of the urethra, over the mouths of the ducts, with M. Lallemand's porte-caustique, has sometimes an excellent effect.

Impotence may be caused in this as in other cases by spermatorrhea; and here I may say a few words on this subject, which to many is one of great importance. Impotence may be the result of anything which tends to weaken, either mentally the venereal appetites, or physically the genital organs. Mentally, the most frequent causes of impotence are-hard study, which consumes the nervous power in a different direction; and still oftener, all the depressing emotions, such as fear, shyness, apathy,

&c., which by their admixture, destroy the force of the venereal appetites. Physically, a want of tone in the genital organs, which are scarcely capable of full erection, at least solely at the stimulus of venereal desires; want of exercise of the organs, which, like all others, are greatly strengthened by habitual exercise; spermatorrhoea, or the general exhaustion of the frame from long disease of any kind. If the disease be of mental origin, John Hunter's advice was, that a man should sleep with the woman, with whom he was impotent, resolving to have no connection with her. A man may be impotent with one woman, into his affections towards whom any of the paralysing feelings enter, and may not be so with another. As a preventive or cure of impotence, the regular exercise of the genital organs, and a healthy life in the open air, without the exhaustion of protracted study, are the best of all means. Besides this, it must be remembered, that there are great natural constitutional differences in these powers in different individuals, and each one must be contented with those which have been given him; and not waste his thoughts and strength, as is so often done, in vain regrets that they are not greater than is natural to him.

Sometimes a gleet will persist in spite of all the above-mentioned remedies, which may not have the power of wholly stopping the discharge, but perhaps of reducing it to a single yellow or gummy drop in the morning, which will not be driven away, and, the moment the remedies are discontinued, increases rapidly till the running be as bad as ever. Sometimes too, the remains of a chordee may continue after the gonorrhoea is cured. In cases of obstinate gleet, various means should be tried.

It must always be borne in mind, that diseases do not become chronic and lingering without a cause. Chronic disease is always a sign, that either the part effected, or the constitution generally, is too weak to throw off its enemy. In a healthy man living in the country, and still more in the vigorous savage in the woods, disease rarely becomes chronic; but wounds and inflammations heal with surprising quickness, aided or unaided, so great are the natural powers. But in the poor unhealthy townsman, the case is very different; every indefinite disease, like inflammation, &c., tends to become chronic, from the weak powers and unhealthy life. This constitutional weakness is in many cases the chief cause of the continuance of a gleet, and must be remedied, before th latter can be got rid of. Thus the man who has an old gleet, should adopt the most bracing life possible; should be in the country, and always in the open air; should live regularly, rising early and going early to bed; should take cold baths, twice or even oftener, daily, remaining in the water only a short time, and always taking a smart walk afterwards, to restore the circulation; and probably a good remedy also, is the cold sitz-bath, taken several times a-day, with a walk after it. These directions which will apply to many other chronic diseases, should at once be adopted, if the powers of the constitution seem inadequate to cure the disease; for delay is, in this complaint, like all others, only wasted time, besides favouring the evil consequences, which may arise from old gleet. Along with these general means, a local treatment