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IV. A I'reatife on the Venereal Dlfeafe. By G.

Renny, furgeon to the Athol Highlanders. 8vo,

Murray, London, 1782. 171 pages. 3s.

IN a fliort introduction to this work the au^

thor offers a few remarks on the caufe on

which the diverfity of treatment of the venereal

difeafe, in its fimple and confirmed ftate, is

founded. Without pretending to determine wher ther the gonorrhcea and confirmed lues are the

effects of the fame virus, he thinks that as it is

certain that in nineiy-nine cafes of a hundred

a gonorrhcea is not fucceeded, by a general lues, this is a fufficient authority for the pradtitioner to regulate the cure upon different principles. The work itfelf is divided into nine chapters.

In the firft chapter Mr. Renn'y treats of the go- norrhoea. This he confiders as an effe<5t of the

inflammation excited in the mucous glands of the urethra, by the venereal poifon: The dif-

eafe, therefore, he thinks is purely local, and

accordingly, in the cure lie infifts chiefly on the

ufe of the following injection, which is to be re- tained for a fhort fpace in the urethra, and ap- plied to every part of the internal membrane by rubbing the finger along the courfe of that tube.

Jfc Calomel, pp. gr. v.

Sacch, Saturn. 3j. Puly,

[ ?46 3

Pulv. e Ceruff. Comp. $j. ' G. Arabic ?fs. folv. in aq. font. bull. ̂ viij.

M. f. inj. During the ufe of this remedy, and while the

difeafe continues, the tefticles are to be care-

fully fufpended, and the patient is dire?ted to

abftain from exercife and inflammatory diet. If

the fymptoms of inflammation run high, the ufe of the injection is to be fufpended till they have been removed by venasfeftion and a gentle purgative.

Mr. Renny clofes his account of the gonor- rhoea with fome remarks on gleets. The caufes

of thefe, he is of opinion, may be referred to

warts in the urethra, to topical irritation uncon-

nected with obftruction, or to a relaxed ftate of

the mucous glands of the urethra, and a debi-

lity of the fyftem in general. Of all thefe caufes, the latter, he obferves, is the moil frequent, being very ufually an attendant on gonorrhoeas, which are treated by the antiphlogiitic method, without the ufe of injection.

In the fecond chapter Mr. Renny treats of in- flammation of the teftis, a fymptom, he obferves, which is fo far from being confined to thofe

cafes where injections are employed in the cure,

that it occurs oftener where the antiphlogiitic tnethod

t 247 ]

method has been purfued, and nothing aftrin-

gent applied, feeming to be the caufe rather

than the effe<5t of a fudden ftoppage of the dis-

charge. This complaint, we are told, feldom occurs

where the tefticles are carefully fufpended. In

proof of this the author informs us, that foon

after his appointment to the furgeoncy of a high- land battalion, four out of eight foldiers, re-

ported with gonorrhoeas, were attacked with in- flammation of the teftis. This he attributed to

their wearing no breeches, and their omitting the ufe of a bag trufs. Since that time, although he has had occafion to treat an hundred cafes of

gonorrhoeas in the fame battalion, yet by taking care to have the tefticles fufpended, an hernia humoralis has been uniformly prevented. The mode of treatment recommended, when

this fymptom has actually taken place, confifts

in general bleeding, the application of leeches to the fcrotum, the ufe of warm fomentations

(in preference to poultices, which are faid to do harm by their weight) and vomits. Mr. Renny prefers clyfters to purgatives as a means of ob- viating coftivenefs in thefe cafes, becaufe pur- gatives are often productive of inconvenience and pain to the patient by obliging him to alter

the

t 248 j

the pofture of his body when going to (tool, aftd this he thinks more than balances fop any good they may do as evacuants.'

In the next chapter the author {peaks- of

chancre. He is of opinion, that every ulcer of this fort is produced by the fame caufe operating originally at the time1 of infection, and not by the difcharge from a particular one begetting a fecond, and fo on. This,- he thinks, is rendered

probable by their number being always deter- minate early, and each ulceration preferving af- terwards its own limits* whereas if this was not the cafe, we might expefl to fee them multiplied ad infinitum, as in the progrefs of the complaint there are few fpots, either on the glans or pre- puce, that are not expofed to the application of the venereal matter. Mr. Renny, confidering a chancre as an effedt of the venereal virus lodg- ing on the part during coition, allows that in fome cafes it may be local; but as in every ul-

ceration there is a ftrong prefumption that an

abforption may have begun, he thinks we have fufficient grounds for confidering chancres as a

complaint in which the habit is almoft certainly affected* and to conduct the cure upon fuch

principles. In conformity to thefe ideas he con- tents himfelf with keeping the ulcer clean, and

drefling

[ *49 ]

drelTmg it with fimple digeftive ointment, and for the' cure relies chiefly on mercurial frictions. The fubjefr of the fourth chapter is phy-

mofis. The author divides this into two fpecies. The firft fpecies we are told is occafioned. by chancres, and diftinguifiled by the hardnefs and thickened ftat'e of the prepuce, and the difcharge from the part. In the fecond fpecies, the com-

plaint may be often traced.from expofure to

cold, and the inflammation, though in general confiderable, is not attended with hardnefs of

the prepuce, but only feems very red, with a

glofTy chryftalline appearance. In both of thefe

fpecies, Mr. Renny thinks mercurials have a

bad effect, whether applied topically or to the

fyftem at large. In the cure he recommends

>the antiphlogiftic method, and the frequent ap- plication of warm milk and water (to the part. "Where the inflammation is independent of chan- cres, he employs a folution of faccharum faturni

as a fomentation, and as. the difeafe is here purely local, he thinks it may in general be cured

without die uie of mercury. He remarks like-

wife that in the phymofis from chancres the in-

guinal glands are for the molt part fwelled, whereas in the more fimple fpecies this fymptom takes place more rarely, and where it does occur Vol. IV. N?III. Ii feems

[ 25? J

feems to be merely the effedt of fympathy, as it

conftantly keeps pace and difappears with the

topical inflammation. Mr. Renny proceeds next to paraphymofis.

Although this fymptom may fometimes be the effect of chancres, yet he is of opinion that in the generality of caies it is occafioned by an in- 'fiammation excited in the glans and prepuce, in

patients who have naturally a difficulty in denud-

ing the penis. There are few cafes, he obferves, in which a timely fcariEcation will do more

good, or where delay will be productive of more

milchief, than in this. The furgeon is therefore directed immediately to make an incifion on

each fide ef the penis, deep enough to remove the ftri?ture effectually, and then to finifh the

cure by proper fomentations and the antiphlo- giftic courle. A few days after the operation, we are told, a confiderable degree of ulceration comes on between the fides of the fofla made

by the ftri&ure. This, which is always a trou-

blefome fymptom, has often been improperly confidered and treated as a mercurial lore. If

the inflammation has advanced fo rapidly as to

fhew every mark of an approaching gangrene before the furseon is called in, he is adviied not tD *

,

to attempt the operation, but to have recourfe to

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to the bark and opium, which are laid to have

produced a wonderful good effect, even in cafes that feemed defperate.

In the fixth chapter the author treats of bubo. A tumour of this fort, he thinks, ought to be

repelled by every means in our power: at the

fame time, however, he confeffes that the^ prac- tice of bringing buboes to a fuppuration is in

general more fuccefsful, as a cafe feldom occurs

where a bubo fuppurates without ending in a

complete cure, and he has very often feen re-

lapfes attendant on their repulfion. This diffe-

rence he attributes to the difficulty with which

patients are induced to continue the ufe of mer-

cury after the tumour is dilperled and they think themfelves well, whereas fo long as any fore re-

mains in the groin they readily fubmit to what- ever is prefcribed.

In the opening of tumours of this fort Mr.

Renny prefers in'cifion to every other method, and thinks it moft advileable, in general, to re- move a circular piece from the forepart of the bubo with a common bifloury. If the fore fpreads, and the difcharge is confiderable, recourfe is to

be had to bark and opiates till the fymptoms are more favourable to the exhibition of mer-

cury.

I i 2 To-

1 , [ 252 ]

Towards the clofe of this chapter Mr. Ren^y offers a few remarks "on warts. T-'hefe he di-

vides into venereal and topical. The former,

he oblerves, difappear with the other fymptoms. The latter are to be removed by cauftic or the

fciffars, and their return prevented by mixing a fmall portion of the powder of favine with the

drefllngs. The next chapter Mr. Renny allots to what

he calls confirmed fymptoms, a mode of expref- iion, as he tells lis, which he adopts rather out of refpeft to the univerfal opinion, than from

any conviction that the particular fymptoms which remain itill to be treated of deferve to be

feparated from chancre and bubo. He firft

fpeaks of ulcerations of the fauces; thefe he

confiders as certain marks of a confirmed lues, and he recommends the fame treatment here as

in, chancres. Excrefcences round the anus and

on the fcrotum require a management fimilar to warts. Venereal ophthalmia is to be obviated by

general and. local evacuations, by the antiphlo- giftic regimen, and the cure finifhed with mer-

cury. Ulcerations on the furface of the body* pains in the head and limbs, difeafes of the

bones, deafneft, &c. are fo complicated with

particular conftitutions and occur fo feldom in.

p'rac-

[ ]

practice of late years, on account of the cure

being fo much better underftood, that he de- clines offering any thing particular on thefe

heads. V

The eighth chapter contains a few obfervations on the preparations of mercury. Thefe are di-

vided by our author into_ the acrid and mild*

Thofe of the latter clafs, he thinks, are in the

end as efficacious as the others, and much eafier to manage. He prefers mercurial ointment to

every other preparation, but if the patient re- fufes to fubmit to this, the common mercurial

pill, triturated with honey or mucilage inftead of turpentine, may be fubftituted.

In the laft chapter of the work the author treats of the action of mercury. He is of opi- nion that in proportion to the more uniform

effect produced by this mineral upon every fe-

cretion, and the lefs tendency it has to run off

by a particular one, fo will it more effentially ferve the curative purpofe it was defignedfor; and upon this principle, that the increafe of

any one fecretion, naturally produces a diminu- tion of every other. Hence he is equally averfe to purging and to falivation. He points out the neceffity of attending to the

fupport of the fyffem during the exhibition of mer-

[ *54 1

mercury, a proper ftrength of circulation Teem-

ing to be peculiarly neceffary to enable it to ex-

pel the venereal virus "completely. Laftly he inculcates the neceflitv there is for continuing the adminiftration of mercury a certain time

after the fymptoms have disappeared. So far the treatment of the dileafe has been

Confidered as applicable to the male fex. In

females, we are told, the cure will be infinitely more fimple, as moll of the topical fymptoms are wanting, and will only differ from the other* in proportion to the delicacy of the female con- ftitution, which will require a greater attention

in the exhibition of mercurials.

The work clofes with a relation of fix cafes, illuftrative of the do<5trines delivered in the pre-

ceding chapters. '