DEP/DUA/1/13/07 (Normalised version)

Daniel Robertson

(1777)

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Next Patient on list Daniel Robertson

Respecting disease with which he is affected no room for entertaining any hesitation.

Can be no doubt that when came under care was affected with Gonorrhoea venereal.

Or that peculiar discharge from urethra which is consequence of a Venereal infection.

This in case before us occurred in most simple state without any appearance, indicating an affection of any other kind.

And if not now entirely removed is at least so far relieved that patient reckons it unnecessary to continue attending longer.

Will not indeed from this pretend to say that discharge may not yet continue for some time

Yet I apprehend can be no doubt in pronouncing favourable prognosis.

And indeed without some fresh appearance should even consider farther treatment as unnecessary.

Or at least would consider nothing more to be requisite than cautious management

In treatment of this case have not employed many medicines.

And at same time these chiefly with intention of obviating symptoms.

Although disposed to think that some have had tendency to radical cure, yet look on recovery to have been more work of nature

This you will observe a treatment very different from what could have followed in cases of Syphilis.

And naturally leads us to consideration of question how far Gonorrhoea & Syphilis are as has generally been supposed to be considered as different modifications of same disease.

Not long ago some may remember that had occasion to mention in practical lectures that lately subject of debate whether human race subjected to one venereal disease only or to two different affections.

Then however could enter no farther into controversy than barely to mention general [head] on which this controversy founded.

Hope however that no apology now necessary for taking more full view of what said on this subject.

Especially as may be considered as a question not merely matter of speculation but connected with practice.

And if shall be able to render it probable that diseases are in reality different will at least be a comforting reflection for those labouring under Gonorrhoea merely to think that not from [illegible] subjected to syphilis.

Am far from imagining indeed that anything which can now advance on this subject will afford satisfactory evidence that the diseases in reality different.

Yet must own that after considering this question am of the two rather inclined to that opinion.

And shall now present with arguments by which disposed to adopt this sentiment.

Before mentioning these however necessary to take notice on what said in support of opposite [illegible]

And endeavour to refute or at least invalidate them

In support of opinion that virus in Gonorrhoea & Syphilis the same many arguments adduced.

Four following however may be considered as those on which greatest stress has been laid.

1^st Observed that both Gonorrhoea & Syphilis very generally affections of same remote cause that is impure coitus.

2. Asserted that from single instance of exposure to infection a patient will be subjected to both diseases of Gonorrhoea & Syphilis.

3. Maintained that from same female & one & same time, one male affected with Syphilis another with Gonorrhoea.

And 4^th Contended that an affection beginning as Gonorrhoea will in consequence of improper treatment be converted into Syphilis.

These arguments must at first sight appear very convincing.

And if well founded to full extent that mentioned would necessarily establish doctrine of diseases being the same.

On accurate examination however will I apprehend by no means be found so conclusive as is in general imagined.

Admitting some strictly true conclusions by no means follows.

And respecting others will not be denied that at least room for deception.

To evince this however necessary to take more particular view of them.

That both diseases by much most frequently at least from same remote cause cannot be doubted.

And with males may be considered as principally if not even solely derived from infection communicated by females.

This however by no means sufficient proof that both of same nature.

And indeed may be considered as merely consequence of both diseases being chiefly seated in organs of generation.

But not more unnatural to suppose two different kinds of infectious matter particularly acting on these organs than one.

And no more argument that matter of Gonorrhoea & Syphilis the same than might be used to prove sameness of matter of Smallpox & itch.

For while two former diseases chiefly obtained in consequence of contact by organs of generation two latter chiefly by [contact] surface.

From remote cause then nothing farther to be inferred than that both the affect of actual contact.

And contact capable of inducing both syphilis & Gonorrhoea when in other ways.

Whenever matter of Syphilis proper [application] to absorption as from suckling an infected child from cutting finger on opening bubo or like syphilis produced.

Application of matter of Gonorrhoea indeed in any other manner than by coitus not so frequent.

But in proof of this also several facts which I apprehend can hardly be disputed.

An ingenious Gentleman a Student at this University about 12 years ago oftener than once gave himself Gonorrhoea by inoculation.

That is by applying matter of Gonorrhoea to point of Urethra on a probe.

But farther observed that application of matter of Gonorrhoea to other mucus glands produced from these similar disease as from those of Urethra.

This I think confirmed by a fact which am well assured happened at this city some years ago.

A young Gentleman labouring under Gonorrhoea employed handkerchief for short time to save shirt.

After obtaining however other clothes, again imprudently put handkerchief in pocket.

And without being aware of consequences afterwards used it in blowing nose.

Effect was a disease of inside of nose & affection of mucous glands these in every respect resembling gonorrhoea.

From these circumstances then appears that present argument far from being conclusive.

And that sameness in remote cause in reality proves nothing farther than that both the affect of contact.

2^den In proof of sameness of matter in both diseases contended that from communion with an infected female for one time only both diseases often the consequence.

This assertion cannot pretend to deny.

But far from proving matters the same.

And perfectly reconcilable with supposition of their being different.

If which often the case female affected with both diseases patient thus equally exposed to both.

No more therefore proof that matter of Syphilis & Gonorrhoea the same than would be afforded of sameness of matter in Syphilis & Variola if both these diseases should be communicated by same person at same time.

And no doubt that has happened in some instances.

No one however thence disposed to imagine that any similarity in matters.

3^d. Argument. From same female one man affected with Syphilis, another with Gonorrhoea.

Of this will hear of numerous instances.

On accurate inquiry however will be found much less frequent than is in general imagined.

In greatest number of instances little certainty from whence infection derived.

Very generally ascribed to most recent suspicious exposure.

When attend however to lurking nature of the disease will appear that in this much room for fallacy.

Well known that syphilis will often appear at intervals of months after infection communicated.

Have known same also happen with regard to Gonorrhoea.

Knew one instance of its making first appearance at end of four months from time of any possible infection.

From these circumstances necessary doubts even where most positively asserted.

But even admitting it true that the two different diseases thus communicated by same female yet proves nothing.

As by no means incompatible with supposition of different matters.

Female may as probably have been subjected to both diseases as to one only.

And no difficulty in supposing that may have communicated one to each.

Had she been also subject to Psora third might have [catched] that infection.

Fourth might have escaped without any disease.

While in fifth may have had conjunction of all three

Even admitting therefore the assertion on which this argument is built to be no rare occurrence by no means proves that matters are the same.

4^th Last argument. that an affection begun as Gonorrhoea will in consequence of improper treatment be converted into Syphilis.

Could this be established would unquestionably prove sameness of matter.

And will meet with many practitioners who will positively affirm that have seen it

Here however more grounds for deception than is commonly imagined.

And on such deceptions the assertion seems to have been founded.

Commonly alleged to be affect of astringent injection at early periods of disease.

And not to be refused that from improper administration of these bad consequences often result

In some instances induces very considerable & obstinate inflammation.

In others & that more frequent too gives rise to swelled testicles.

Neither one nor other of these however in such cases to be reckoned Syphilitic symptoms

But merely affects of inflammation induced by sudden change in state of circulation.

And accordingly cured by use of antiphlogistics regimen & medicine.

Not to be denied indeed that cases where syphilis has succeeded Gonorrhoea.

But as frequently happens where Gonorrhoea [illegible] in most judicious & cautious manner as when precipitately cured.

Nor is it necessary for explanation that should adopt supposition of two diseases depending on same [illegible]

As easily explained on supposition that patient had received both infections.

But that for some time one had remained latent

A circumstance which have already observed frequently happens where one only communicated.

There take to be chief argument adduced in support of opinion that matter giving infection of Gonorrhoea & Syphilis in reality of same nature.

And from examination of these appears that by no means so conclusive as is in general imagined.