Encyclopaedia Britannica, or, a Dictionary of arts, sciences, and miscellaneous literature : enlarged and improved. Illustrated with nearly six hundred engravings > Volume 13, MAT-MIC

446 M E D I
Apocenofes. than in men. Sometimes the vagina only is affecled *7
^ and when this happens, the fymptoms are very trifling:
but in general it comes on with an itching and fenfation
of heat as in the other fex $ and is attended with in¬
flammation of the nymphae, in fide of the Inbia, clitoris,
cantnculcT mjrtformes, the orifice and fometitnes the
whole of the meatus urinarius* Very often the deep-
feated glands of the vagina are affected, and it is fome-
times difficult to diftinguilh tlie difeharge of a go¬
norrhoea from that of the ffuor albus.
Caufos, &c. Many ingenious arguments have of
late been advanced to prove, that the gonorrhoea and
the lues venerea are different affe£tions, originating
ifrom two drftimft fpecies of virus } and this contro-
verfy ftill, perhaps, remains to be decided by future
fafts. Certain it is, that in 19 of 20 cafes of gonor¬
rhoea, no fymptom whatever of fiphylis appears j and
that the difeafe readily admits of cure without having
recourfe to thofe remedies which are univerfally requi¬
site for combating the contagion of fiphylis. It is by
no means wonderful, that in fome cafes both conta¬
gions, fuppofing them different, fhould be communi¬
cated at the fame time. Nay, cafes are by no means
rare, ivhere the contagion of itch, though effentially
different from both, has been communicated with ci¬
ther. But as undeniable proof that the contagion in
both cafes is precifely the fame, it has been alleged by
fome, that the matter of a chancre introduced into the
urethra will generate a gonorrhoea, and that the dif¬
eharge from a gonorrhoea will produce chancre, bubo,
and every other fymptom of fiphylis. On the other
hand, however, it is contended, that when experiments
of this nature are conducted with the greateft accu¬
racy, the matter of fiphylis uniformly produces fiphy¬
lis, and that of gonorrhoea, gonorrhoea only. With¬
out pretending to decide on which of thefe experi¬
ments the greateft dependence is to be put, we may
only obferve, that while an almoft inconceivably fmall
portion of fiphylitie matter applied to the glans penis,
from connexion with an infected female, infallibly
produces fiphylis if it be not fpeedily removed, the
matter of gonorrhoea, in every inftance of that difeafe,
is applied to the whole furface of the glans penis for
many days together without producing almoft any bad
effe6t whatever. From this, therefore, there is ground
for inferring, either that it is not capable of being ab-
forbed, or that if abforbed it is innocent.
But while there have been difputes with regard to
the peculiar nature of the matter in gonorrhoea, there
have alfo been controverfies with refpeft to the fource
from whence it is derived. While fome fuppofe it to
be principally purulent matter arifing from ulcerations,
others aflert that no fueh ulceration is ever produced iti
the urethra by gonorrhoea. They contend that the in-
creafed fecretien in thefe cafes is exactly limilar to
what happens in the catarrh. But the comparifon
will by no means hold good in every particular: in the
latter the whole membrane of the nofe is equally irri¬
tated whereas in the gonorrhoea, only particular parts
of the urethra feem to be a fit* tied. The difeafe, in
the generality of cafes, feldom extends more than an
inch and a half along that canal, and in many is con¬
fined (at leaft in the beginning) to a fmall fpot about
an inch from the extremity of the glans. The dif-
CINE. Pradicc,
charge is produced from that part 0? the urethra where Gonorrhcea
the pain is felt j and the patient, when he voids his ‘'"•“■v-—1
mine, feels no fmarting till it reaches the inflamed fpot:
but as the diforder increafes, the inflammation aftefts
a greater number of points, juft in the lame manner aa
chancres affe<ft different parts of the glans. It might
be fuppofed that dilieftion would at once clear up this
matter, and put an end to the difpute j but this is far
from being the cafe. Dr Simmons has feen feveral
urethras opened in perfons who had a gonorrhoea at
the time of their death : in three of them the furface
of the urethra, as un the cafes related by Morgagni,
appeared for fome way down of a llight red colour,
and in all of them was covered w ith mucus j but with¬
out any appearance of ulceration, except in two diflec¬
tions at Paris, in which moft of the gentlemen prefent
were convinced that they faw evident marks of it:
but Dr Simmons lays that the appearances W'ere to
him not fufficiently fatisfafrory to enable him to decide
with certainty on the fubjetft. On the other hand,
when we confider that the difeharge in a gonorrhcea is
fometimes tinged with blood, and that when this hap¬
pens a little blood veffel is no doubt ruptured, we
can have nq reafon to doubt that an ulceration may,
and fometimes does, happen in thefe cafes 5 efpecialiy
as we often obferve an excoriation near the orifice of
the urethra. It is certain, that uherever there is con-
fiderable inflammation, there will be danger of ulcera¬
tion. Befides, from a negle&ed or badly-treated go¬
norrhoea, avc often fee fiitulas in perinea, and other ul¬
cers of the urethra, penetrating through its fubftance,
and affording a paflage to the urine. And there can
be no doubt that flight ulcerations of this canal often
occur, and are afterwards perfeftly obliterated, in a
fimilar manner to what happens in the papillae of the
tongue, the tonfils, &c. Such an obliteration will
the more readily take place in a part like the urethra,
defended with mucus, and not expofed to the air,
which is known to have no little eft'eft in hardening a
cicatrix.
But whether ulcers take place or not, whether the
virus of gonorrhoea be precifely of the fame kind with
that which gives fiphylis, or of a different kind, there
is reafon from the phenomena of the difeafe to con¬
clude, that the matter firft acts by mixing with the
mucus at the extremity of the urethra ; and that from
thence it is propagated uprvards, particularly where the
excretories of mucus are moft numerous •, and that on
the parts to -which it is applied, it operates as a peculiar
irritating caufe. The confequences of this irritation
will be inflammation and an increafed fecretion of
mucus 5 and fo fat the complaint will be local. In
ninety-nine cafes of an hundred, a local affection of this
kind conftitutes the whole of the difeafe ; and of this
inflammation, ulcerations within the urethra, ftrfelures,
and other local affc&ions, may be the confiquence.
But whether a difeafe of the habit ever takes place,
unlefs when the contagion of fiphylis is communicated
with that of gonorrhoea, ftill remains to be determined
by future obfervations and experiments.
Nothing can be more variable than the period at
which the difeafe makes its appearance after infeftion-
Perhaps, at a medium, vre may place it between the
4th and 14th day : but in fome cafes it happens within
>4