On the Nature and Effects of Syphilitic Agonorrhoea. By DR. FELIX PASCALIS, in a Letter to the Editor.

IF

SIR,

you will do me the favour to admit into your valuable Museum, the following remarks on fyphilitic Agonorrhœa,' which have been drawn up with a diffidence commenfurate with the novelty of the subject; and if it can furnish hints enough for a clear and fatisfactory investigation of that complaint, to fome abler and more experienced physician, I shall feel myself highly gratified.

PHILADELPHIA, February 15th, 1805.

Yours, refpectfully, &c.

FELIX PASCALIS.

A GENTLEMAN from one of the fouthern ftates applied to me five years ago, for medical aid in his complaint, which he called nervous, and which he defcribed very confusedly; for "he never was fick," faid he, "but he never was well." His emaciation and debility, with a remarkable drynefs of a much wrinkled fkin, were fo vifible, as to give him the appearance of declining age, although he was 45 years only. A few of the gratifications of the fenfes remained to him. He flept little indeed; he relished no kind of nourishment, and his eye-fight was fast failing. To relieve his uneafy sensations, he was obliged to refort to the ufe of fpirituous liquors (which he disapproved of very much), and also to high-seasoned meats, by which means he could relieve the deadly feelings arifing from

* The addition of the Greek negative ', to that old technical name is obvious: but I regret that the whole of it is incorrect; yovn femen, should be exploded, with the belief of the ancients, of the nature of that disorder. @ or Siphno, the island of impures, might give a better and more correct idea, by calling it fipbnorrbea or afiphnorrhea.

his abdomen. By all accounts, indeed, his ftomach, kidneys, and bladder feemed to be the feat of numbnefs and flight pains. Great flatulencies incommoded him very much. Above all, he feared a kind of gravelly disorder, for he constantly was fubject to a troublesome dyfuria. No better account could be given to me, although I urged as many questions as chronic and fymptomatic caufes might fuggeft, and, what reduced still more for me, the chapter of conjectures, was the perfect state of health of his amiable family, compofed of a wife and five children, and his abfolute forbearance of any kind of excess or debauchery during the last five years, to which he had, however, been expofed before that period. He remembered that having participated once in convivial liberties, he had been thrown among impures; but no foul disorder was contracted, às he was well convinced, by having not known any of the ufual fymptoms, and by medical authority. He was aware, notwithstanding, that his miferies had begun from, and continued fince, that period.

I begged to have time to confider a cafe very fingular and obfcure in its diagnostics; and this I protracted; yet, as I found I could not remedy it, unless by means repugnant to a patient prejudiced against any fufpicion of an existing venereal diforder, I determined at laft upon a mode of treatment, without certainty, or any facts whatever in fupport of the opinion I had formed of the disease. At first a bougie was introduced into the urethra with much facility, and with as little pain as if the parts had been palfied, except under the prostate, where a little preffure was requifite to penetrate into the cavity of the bladder. Warm bathings, a mild and reduced diet, with two nitrous and mercurial dofes, were all the prefcriptions to be obferved each day; and after this method had been purfued five days, the glans appeared tumefied, the urethra became painful, and the ufual dyfuria far more diftreffing than before. This state I could not keep up much longer after the bougie had been introduced five or fix times, as a violent chordee with copious and puriform discharges took place, which in a

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few days I was obliged to counteract by bleeding and other ufual remedies. That the matter had a degree of venereal acrimony, I had the proof, as it excoriated the glans; and, that it answered perfectly to the critical fecretion of the infected membrane of the urethra which constitutes a gonorrhoea, I thought was obvious by the quality and fucceffive colours of the discharges. With a gradual abatement, however, and alteration, the complaint became a fimple gleet after twenty days, and in ten days more, it perfectly fubfided, and the patient gradually recovered his former and youthful health. I had the opportunity to fee him again a year after, when he confirmed by his bodily appearance and by his candid accounts, the abfolute ceffation of his nervous and formerly diftreffing fenfations.

There appears no difficulty, Sir, to explain fuch an extraordinary cafe, if we advert to the idiofyncracy of the subject, in whom, the parts affected could never be raised up to that degree of inflammation which is neceffary to promote suppurative discharges, by the fole irritation or stimulus of the existing virus. The fame want of inflammation has been obferved fometimes in large wounds, in fractured bones, and even in felons and whitlows, which thereby are aggravated and attended with terrible effects, efpecially on the nervous fyftem. This is, I believe, the best scale to go by, when we must judge of the extent of a morbid ftimulus. Thus the tetanus and chorea Sancti Viti, are now easily traced to deep lacerations, contufions, or morbid causes that are deprived of inflammation, or digestive refolution. Thefe general obfervations render it very probable, that with the fame circumftances, an impure connection may constitute an agonorrhea, with a dreadful reaction on the neryous fyftem. A few facts more must be fufficient to establish this doctrine, and thefe have not been wanting to me after five or fix years of obfervation on that very fubject. Medical inquiry, indeed, to be useful, requires only that we should hold fuch grounds or principles as we may reasonably apply to facts as they occur. Among thefe, and in three inftances which I should think too tedious to defcribe, the fame cause and the

fame effects were illuftrated; and in others, I moreover, remedied or abstracted the inflammation of the virus from more delicate parts, fuch as the prostate, the testicles, &c. by fixing it in the urethra. It was with the obvious fuccefs of an artificial irritation in certain cafes, that the celebrated Daran, of France, fupported the discovery of his bougies, and pretended, that, with certain ingredients, they were a specific remedy for gonorrhoea indeed any thing that promotes a discharge from the urethra, is finally, the best known remedy of the cause and of its fymptoms. But unfortunately, Daran gave out his remedy as a quack, and indifcriminately, for any degree or ftage of the complaint; he resembled Sanctorius, who having discovered the infenfible perfpiration, published his aphorifms to cure all diseases by fweating. Thus a good remedy is often difcredited by being too often mifapplied.

Let us illuftrate, however, by further observation, both the remedy and the true existence of a syphilitic agonorrhea.

I. Whether the irritability of the membrane of the urethra is, fui generis, or whether it is but a quantum of that, which, by our Maker is wifely diftributed to all our organs, although in different degrees, it appears that it can be increafed or entirely. destroyed. Thus, when it is accumulated, during the act of generation or erection, it can hardly bear the prefence of urine, and will fuffer no inconvenience from that of the femen. On the contrary, it may be eafily overcome by frequent contact with bougies, catheters, or even of acrid fluids administered in injection, and will not be affected with the least pain or uneafinefs. From this we may infer, therefore, that however ftimulating the venereal poison must be, when applied to the mucous membrane of the urethra; circumftances in the conftitution may have diminished the quantum of irritability of those parts, or fuch a length of time may have elapfed before an inflammation could be determined, that the morbid action has become habitual, and no puriform fecretion can be afterward effected, unless it is excited by artificial means, or by the addition of any stimulus whatever. I confefs, Sir, that the prefence of a con

tagious poison thus rendered latent, inactive, and free from its impending and deleterious effects, without ever being exhausted. or altered in its virulence, and that, during the space of many years, is a phenomenon incomprehenfible; yet it is evidently proven and inferred, from the known and fimilar effects of other specific and contagious poisons, from that of the terrible hydrophobia, to the mild virus of the vaccine: for we are indeed apprifed, that although they must be feverally brought into ac tion within a certain period of time, this has been found variable, fometimes much shortened, as in the confluent small pox, and fometimes protracted to fix months, one year, and even twenty years, as it has been ascertained of the hydrophobia. But another difficulty is in the way; it is that of conciliating the inactivity of the poifon thus received, with its fingular effects on the conftitution and nerves, as exemplified in the above mentioned case of agonorrhea, and by still more dreadful affections, fuch as mental derangement, as I have seen in the infectious operation of other deleterious caufes! why, if there exists an irritating or morbid principle, it does not follow from its being latent and inert, that it should not affect the general and animal irritability, even to the utmost degree. Thus, a nail has deeply wounded the foot; the pain is gone, no inflammation appears, but the tetanus takes place! A girl of the age of thirteen years was once exposed to the fmall pox by infection, and received it, when the moft severe attacks of epilepfy enfued, as it were, by tertian paroxyfms; they baffled every remedy during two weeks, until the worst kind of small pox broke out, from which she recovered with difficulty, but the epilepfy never took place again. We have it here, and in numerous inftances well known to medical philofophers, demonftrated, that while a contagious poifon is rendered inert, and while the peculiar operation which belongs to itself is fufpended, the morbid cause has yet a great power on the general fyftem of irritability, that is to fay, on the nerves. I am happy to find a theory to fupport this phyfiological law, mafterly explained by