advantage to our country, would cost her nothing to put into execution; and which, while it must sooth the breast of the man who procured its adoption, as the performance of a great virtue, would ensure him an endless fame in the remembrance of a grateful posterity. T. F. VIII. Account of two Cases of Gonorrhoea, attended with unusually severe symptoms, relieved by the Employment of Calomel and Opium in combination. By GEORGE LANGSTAFF, Member of the Royal College of Surgeons, London. Do URING the early stage of gonorrhoea virulenta, the symptoms are generally pretty regular, consisting of occasional twinging pain, ardor urinæ, discharge from the urethra, and frequently chordee; but their degree of violence, influenced, perhaps, by the nature of the infection, depends chiefly on idiosyncracy, and is often increased by intemperance. However, we occasionally meet with great deviations from the regular order in this, as well as in other diseases, of which the following case is a remarkable instance. Mr JOHN HART, 39 years of age, of a plethoric habit, applied to me on the 10th of June, with gonorrhoea, which had made its appearance nearly a week. The glans penis, and orifice of the urethra, were much swollen, and he complained of violent heat and pain in making water. The discharge from the urethra was copious, of a yellowish colour, tinged with green. He was directed to keep a cloth to the penis, damped with cold water, as often as he conveniently could; opening medicine was given, and the following powder prescribed : B. Pulv. tragacanthæ comp. 3ss. Jalapæ gr. iv. m. f. pulvis. Ter die sumendus, in poculo aq. hordei comp. This method of moderating the ordinary inflammatory symp. toms, aided by the antiphlogistic regimen (with local and general bleeding where the case requires), I have mostly found successful; and when the ardor urinæ is troublesome, I commonly order from ten to twenty drops of liquor potassæ to be taken with each powder, until the pain moderates. But this remedy is rather uncertain in its effects; for though it sometimes allays the above-mentioned symptom, in the most surprising and satisfactory manner, in other cases it does not afford the least alleviation, either in increased or diminished doses." The inflammatory symptoms continued violent, and the ardor urinæ very troublesome, till the 17th of the same month, when the swelling, inflammation, and heat, had lessened considerably. The discharge was still profuse, and of a purulent colour. The powders were continued, but the liquor potass was omitted, as the pain, in evacuating the urine, had so much diminished; but as he complained of slight erection of the penis in the night, attended with pain, a pill, with one grain of opium, and two of camphor, was directed to be taken every night, and the penis to be bathed in warm water. Under this mode of treatment, the symptoms gradually decreased, and there was every reason to suppose the disease would run its course in a favourable way; but on the thirtieth, the inflammatory symptoms recurred with redoubled violence, without any assignable cause, and the patient was troubled with frequent painful erections of the penis. The warm bath was used, a pint of blood taken from the arm, (which after standing a while proved sizey, or what is termed inflamed), and saline purgatives, with demulcent beverage, were prescribed. On the 2d of July the patient called on me, nearly distracted with pain; he had not voided his urine for twelve hours, and had, during the last two, suffered the greatest agony from the urgent inclination to do so. In addition to his misery, the penis had been distended with blood to an enormous size nearly six hours, and he had not been able to moderate the erection by cold, or any other means he had tried; the discharge was much diminished. Cold and warm water having been used without effect, it was necessary to adopt some effectual mode of relief. I thought the introduction of the catheter would be the most likely method of lessening the irritable state of the bladder. I employed a moderate sized silver instrument, which passed easily, with its convexity towards the arch of the pubis; but when I had turned the handle, and attempted to carry the point into the bladder, though it was done in the most cautious manner, violent spasm affected the parts, and obliged me to withdraw the catheter when, to my astonishment, nearly half a pint of arterial blood flowed in a moderate stream from the urethra. A discharge of blood from the urethra is not an unfrequent occurrence, when the inflammatory symptoms of gonorrhoea run high; and it generally gives temporary ease, as it did in this case. But as the bleeding still continued, l'introduced a common bougie, which plan I have often seen succeed in suppressing hæmorrhage, brought on by the use of the caustic. I had also in view the further motive of promoting the evacuation of the bladder; which very fortunately succeeded; for as soon as the bougie was withdrawn, the urine flowed to the quantity of a pint; the penis became flaccid, the hæmorrhage ceased, and the patient was freed from pain. After this relief, the patient was ordered to take a pill, with two grains of calomel and one of opium; to sit over the steam of warm water, and to foment the parts frequently; low diet was also enjoined, with a view of lessening the inflammation and irritation of the urethra, and (I may add) bladder; for if we may be allowed to judge from the nature and violence of the symptoms, the whole mucous lining of both was affected. Mr Hunter says, * "The ureters, and even the kidneys, sometimes sympathize, when the bladder is either very much inflamed, or under a considerable degree of irritation: however, this but rerely happens, and if it should take place with any degree of violence, I should suppose that the stomach would also become affected, and of course the whole constitution. The same author further adds: "When the inflammation, or perhaps only the irritation, runs along the whole surface of the urethra, attacks the bladder, and even extends to the ureters and the kidneys, so as to cause a disagreeable sensation in all these parts, the disease is generally very violent, and, I suspect, is something of the erysipelatous kind; at least, it shows an irritable sympathizing habit. " July 3d.-About seven o'clock this morning, the distension of the penis was as great as yesterday, attended with retention of urine, and violent efforts to void it; the painful sensations were so distressing, as to compel him to send for me about ten o'clock. A bougie was introduced, and upwards of a pint of offensive urine, loaded with mucus, came off, attended with the same pleasant relief as yesterday. Leeches were applied along the course of the urethra, and to the perinæum, which caused a copious flow of blood; and the warm bath, and the following mixture and pills were ordered: B. Pulv. acacia 3ss. Pulv. ipecacuanhæ comp. ij. Sqr. althææ 3ss. Aquæ menthæ virid. vij. m. Sumat quartam partem quarta quaque horâ. * First Edition, p. 43. Extracti opii purif. gr. ij. f. pilula horâ somni sumenda. About seven o'clock in the evening, the symptoms again returned, and were so tormenting, as to oblige me to use a bougie, when about half a pint of the same kind of urine flowed immediately. July 4th. The erection not so teazing last night, but the priapism and retention of urine this day so urgent, as to require the aid of the bougie. Leeches were again applied to the perinæum and urethra, and the mixture and anodyne pill were ordered to be continued. * July 5th. The penis had been erect, without the smallest incurvation, all last night, and was this morning swollen to an enormous size; the glans looked as if on the point of bursting; the integuments of the penis and scrotum were much discoloured, with erysipelatous inflammation; and the urgency to expel the urine was so great, and attended with such acute pain in the hypogastric region and penis, that I really thought the man would be deprived of his senses, or that he would commit suicide. The abdominal muscles seemed to sympathize with the propelling action of the bladder, even contrary to the will of the patient, and tended materially to increase his sufferings; and from the. frequent expulsatory efforts, with the pain and weakness he complained of in the situation of the abdominal rings, (where there were evident protuberances), I was apprehensive herniæ would be produced, and therefore took necessary steps to prevent, if possible, such a calamitous event. I endeavoured to make him sensible of the abdominal muscles being partly voluntary agents, that he might endeavour to prevent their violent synchronous action with the bladder; but this he could not now do, as they had become sympathetically involuntary. By means of cold applications, and pressure with my hands, I attempted to repel the blood from the penis, in order to introduce a bougie, whilst it was in a state of flaccidity; this, however, could not be achieved, owing to the extreme pain the pressure produced. I was therefore under the necessity of using it during the erected state, and though not more than half a pint of urine was evacuated, the pain and erection immediately ceased. * Extractum conii, and extractum hyoscyami were tried without effect; also opiate clysters. After withdrawing the bougie, the same quantity of urine was made, under similar circumstances, in the evening. The mixture and pill were ordered to be continued, as yesterday, and he was requested to apply cold water to the perineum and penis, as often as conveniency would permit. July 6th.-Though the symptoms were not so violent as yesterday, yet he could not evacuate the contents of his bladder, without the assistance of a bougie, which was used twice this day; when not more than twelve ounces of urine flowed each time. July 7th.-During last night the patient experienced agonizing pain, owing to the violence of the erection, accompanied with urgency to make water. These symptoms were this morning again relieved, by the introduction of a bougie. As his bowels were rather costive, probably from the opium, a mixture, with sulphas magnesiæ cum infus. sennæ was prescribed, and the following pills. B. Submuriatis hydrargyri, This evening, about half an hour after taking the first pill,. he was, to use his own expression, happily surprised, by making, with perfect ease, upwards of a pint of urine, of a very turbid colour. He slept comfortably all the night, and repeated the pill in the morning of the 8th, with the same good effect as yester day. The patient seemed confident the pleasant change in the nature of his complaint was ascribable to the pills. I must, however, confess, that I did not believe it likely they would produce so sudden a relief; and was more induced to suppose, that the turbulent symptoms had run their course, and were beginning to moderate. As opium without calomel did not allay the violence of the symptoms, I was induced to join the latter, with a view of counteracting the effect of it on the bowels; and having given similar pills, with the most decided advantage in those unpleasant symptoms which occasionally come on about the latter part of the inflammatory stage of gonorrhoea virulenta, viz. irritation of the neck of the bladder, attended with constant inclination to evacuate the urine, violent pain in discharging the last drops, (owing to the spasmodic action of the musculi acceleratores urinæ), sense of weight about the perinæum and anus, tenesmus, &c. &c. I was determined to give them a fair trial in the present case; and I feel a pleasure in stating, that they exceeded my expectation, as |