CHAPTER VIII.

TREATMENT OF SYPHILIS.

We now come to that part of the subject which is, or should be, the end and aim of the practical surgeon, namely, cure. But before engaging with the question of cure, there is another, of equal importance, which first claims our attention, namely, prophylaxis, or prevention.

PROPHYLACTIC TREATMENT.

The first condition of "taking" the disease is the con'tact of morbid secretions with some part of the genital organs, either the mucous membrane or the skin: the time requisite for the continuance of the contact is probably very short, particularly in the case of the mucous membrane; but time is necessary, and upon this circumstance turns the most important of the rules of prevention, namely, careful washing with soap and water. This operation should be done well, and immediately after connection, and if it be done well, I think it impossible that absorption can take place, that is, in the male. The female is placed in a position of greater difficulty than the male; the poison in her case is conveyed to a situation where washing must necessarily be imperfect. Injection, so far as the vagina is concerned, is her only resource; but so far as affects the external organs, where primary disease most commonly manifests itself,

the powers of soap and water will be as potent for her, if properly used, as for the male.

The best injection for the use of the female, in the case to which I am now referring, is weak vinegar and water. She should first wash with soap and water fully, perfectly, and abundantly, then inject the weak vinegar and water, and then bathe herself outwardly with the same fluid. The man should do the same, saving the injection, which is by no means necessary. In both, it is desirable to make water as soon after connection as may be, in order to wash the aperture of the urethra free from any secretion that may have settled there.

The common situation of development of a venereal sore is among the folds of the prepuce, in the fossa coronæ glandis, and particularly in the smaller and more occult folds of the frænum. It may call for considerable care to expunge any morbid secretions from these situations, and the operation is not one that should be performed negligently or hastily. If a man have a venereal sore on the body of the penis, why, he richly' deserves it, for nothing but gross neglect could have allowed the contact of the poisonous secretion for the length of time necessary for absorption, and particularly by the skin, which is not so apt at absorption as the mucous membrane. I have lately seen two instances, in which the sore was developed amongst the hair at the root of the penis. Here it is obvious that the washing had been imperfect, as not having reached that part, and probably the sufferers were not prepared for the development of a sore at so distant a point. This is only a reason for urging the application of the washing the most extensively possible.

Acids and alkalies possess the power of destroying the poisonous qualities of the syphilitic poison.

After the washing has been thoroughly effected, the organ should be made perfectly dry, otherwise the moisture left by the ablution may only serve to effect the solution of some undisturbed atom1 of the poison, and facilitate its absorption.

The power of oil of forming a kind of varnish to the skin, and preventing the contact of moisture for a time, might also be advantageously put in operation as a defence against the syphilitic poison, and as an antecedent, where careful washing is to follow as a subsequent. But it must not be relied upon as a sole defence; nothing should be permitted to interfere with the after action of the soap and water.

Where a man is determined to rush into danger, the prepared cæcum of the sheep may be advised as a protection. It is one of great efficiency, and we are occasionally consulted under circumstances which render it necessary that we should be aware of the existence of such a remedy. The unexperienced may deride the suggestion, but the man of the world will appreciate its value.

To woman, alas! we have no suggestion to offer, but that of inunction before, and soap and water and vinegar and water after, the act.

There is a case in which the cæcum of the sheep becomes an all-important remedy, and where duty as well as security requires its use, namely, when a husband is suffering under chancre, and is anxious to conceal his misfortune.

I need hardly say that ablution should not be confined to the hour; but should be performed daily, or at retiring

In reference to the reproductive powers of the poison, Mr. Acton observes: "To show the infinitesimal quantity of virus necessary for producing specific effects, one drop has been diluted with a pint of water, and the inoculated fluid has produced a pustule," (p. 353, second edition.)

at night, and at rising in the morning, until the time of danger is past.

And then, we may be asked, what is that time? For the mucous membrane it may be two, three, or more days; for the skin it may be as many weeks. In the instance (case 59) to which I have referred more than once, the venereal sore was four weeks before it made its appearance.

Another question is frequently put to us: Is washing a certain preventive? The answer is simple: No; for ablution may be imperfect; the poison may have become insinuated into some aperture of a follicle, some crevice, some undiscovered nook, where the soap and the water are incapable of reaching it; but this I regard as an exceptional case. I have at this moment under my care a medical student with constitutional syphilis, who declares that he did wash, and immediately after the act. I can only not believe him, or rather that he could have performed the operation thoroughly; that he did not do so effectually is quite evident, unless we give him the benefit of an exception, which I must confess myself unwilling to grant without cogent reasons.

In addition to efficient washing, certain astringent and stimulant lotions might be recommended; such as a solution of the super-sulphate of alumina, in the proportion of two drachms to the pint; a lotion of tannic acid, one drachm to the pint; port wine, diluted with six parts of water; eau de Cologne, diluted with ten or twelve parts of water, and so forth. But these applications must all be considered as secondary to the saponaceous ablution.

If the skin or mucous membrane be abraded or torn, so as to give rise to an excoriation, the stick of nitrate of silver should be passed over the abraded surface, and a piece of lint placed upon it, so as to prevent its contact