DEP/DUA/1/13/08 (Normalised version)

Daniel Robertson

(1777)

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At last lecture entered on consideration of case of Daniel Robertson.

A patient who came under care for Gonorrhoea Virulenta or Simple Clap

Respecting nature of this affection has of late been subject of dispute whether infected matter of same kind with that of Gonorrhoea or of different kind

Or in other words whether [have] species subject to one or two Venereal Diseases.

First of these opinions viz that are the same is at least by much most generally received.

Must own however that cannot help entertaining doubts with regard to it

And have entered at some length into consideration of arguments brought in support of it.

After endeavouring therefore to refute or at least invalidate proof of this hypothesis [conv] next to consider second.

Supposing viz. that matter of Gonorrhoea & Syphilis are in reality essentially different.

Argument brought in support of this hypothesis drawn from various sources.

But chiefly from these following.

1 From History of two affections.

2. From phenomenon which the disease exhibits

3. From method of cure.

History of two affections affords many circumstances corroborating opinion of being different.

This particularly appears from progress in Europe & in other countries to which are an import.

Very generally allowed that whether diseases in reality of same or different nature, both but of recent date in Europe.

Of late indeed in elaborate treatise written by Mr [illegible] a French author, to prove that older in Europe than commonly believed.

But notwithstanding what said to contrary good reason for believing that neither affection known till discovery of America.

Subject of first appearance in Europe more [laboured] by Dr Astruc than any other writer.

And has been at utmost pains in collecting facts on this subject.

On this authority appears that both diseases not imported to Europe at same time.

But that Syphilis had been observed forty years before Gonorrhoea known.

This may farther be remarked not peculiar to Europe.

But has held also of other countries to which Syphilis has been carried from Europe

Syphilis for example very soon imported to China

But Gonorrhoea did not appear there for many years after.

And when Astruc wrote had been but for short time known among them.

Probably as being less obstinate disease from length of voyage very generally cured before reaching that country.

Or at least although running might in some degree remain yet virulence overcome.

These facts corroborated by an observation of still later date.

Importation viz of the Venereal disease to islands lately discovered in South [seas] particularly Olahite.

Certain that unknown there till visited by late circumnavigation.

And yet a matter of dispute whether first communicated by the French or English

For was visited by both nations pretty nearly about same time

And each willing to throw [illegible] of it on other.

But by however imported would appear that carried there one disease only.

Am informed by a Gentleman whose accuracy may be relied upon in this matter who visited that island with Captain Cook in last voyage that then Gonorrhoea unknown.

This however could hardly suppose to be the case did both depend on same infected matter

Thus then would appear that from history of the diseases several circumstances which would lead to supposition of diseases being in reality different.

2^d Set of Arguments drawn from Phaenomena.

Among these many particulars pointed out giving presumption that matter of Syphilis & of Gonorrhoea essentially different.

Observed that Syphilis when neglected uniformly increases in violence.

And if not artificially removed terminates in death of the patient.

Gonorrhoea on other hand no such progress.

Is even a disease when after running certain course has natural tendency to cure

And in many cases if patient lives moderately & avoids causes inducing inflammation natural cure will soon take place

Many practitioners even so much convinced of this that reckon medicine in this disease unnecessary.

Or merely direct such as may please & amuse the patient

Am far however from contented for truth of this opinion to utmost extent.

Hold use of remedy to be in many case of utmost consequence.

But still must be allowed that this in most cases may be neglected without any great danger.

And in general neglect productive of no other affect than to render present symptoms more uneasy & cure more tedious.

Can therefore be no dispute that in as far as respects progress of [effectiveness] phaenomena of the diseases essentially different.

2^d. Phenomena marked out as demonstrating difference is that infected matter of syphilis uniformly produced syphilis of Gonorrhoea Gonorrhoea.

Already indeed observed that with regard to matter giving infection in ordinary cases in the dark.

Few fools hardy enough to expose themselves where certainty of existence of either.

But where affection of person giving the disease afterwards known, very generally observed that whether Syphilis or Gonorrhoea person infected receives same complaint.

Dr Boerhaave has positively asserted that never knew any one with Gonorrhoea alone give syphilis.

And perhaps as accurate an observer as ever lived either before or since.

In general as certain that one Gonorrhoea consequence of another as that smallpox gives smallpox.

No one ever Gonorrhoea from [illegible] finger in opening bubo.

No [none] ever Gonorrhoea from suckling syphilitic infant.

Or at least if Mary Kennedy patient at present under our care an instance of this is first that have ever either seen or heard of.

And should it even be found that she has Gonorrhoea does not follow that got it by nursing.

For this may be alleged when had it either from husband or from another quarter

Besides in no instance where Gonorrhoea received by inoculation did any symptoms of syphilis ever appear.

Would appear then that each disease uniformly consequence of a particular infected matter.

And whenever certain of what nature that is, may also be certain of disease which will follow.

A third particular from phaenomena confirming difference is drawn from disease so frequently [remaining] separate.

Must indeed be allowed that not infrequently conjoined

Yet in by much greater number of instances each runs course without least appearance of other.

Has sometimes indeed been said that Gonorrhoea converted into Lues.

But never even alleged that Lues [converted] into Gonorrhoea.

Would naturally expect however that such alternation should frequently happen were infected matters the same.

Would naturally expect that when matter of syphilis acts on almost every other part of system should by action on penis induce running.

This however not observed to happen.

Hence while so great reason to believe that is applied are led to infer that in nature different from that giving rise to Gonorrhoea.

Has indeed been alleged that Gonorrhoea in some instances gives rise to Syphilis.

Have however pointed out several circumstances leading to ambiguity in this respect.

And at least certain that if any [instances] do occur are very rare.

But were infected matters of same nature instances of Syphilis from Gonorrhoea could neither be rare nor ambiguous.

And indeed in every case where Gonorrhoea existed Syphilis should follow.

In every instance of Gonorrhoea infected matter necessarily applied to numerous [illegible] of absorbents on glans.

Certain however that in by much greater number of cases no inconvenience from thence

And in 99 at least of hundred no appearance of Syphilis.

Can only however suppose this to [happen] in consequence of one of two circumstances

Either this matter incapable of being absorbed

Or although absorbed is innocent

Whichever supposition adopted however leads to conclusion that matter of syphilis & Gonorrhoea essentially different.

3^d & last set of arguments are those drawn from method of cure.

Certain that remedy by which one overcome essentially different from those curing the other

Formerly ordered practice in every instance of Gonorrhoea to employ Mercury.

And perhaps where reason to apprehend that syphilitic taint at same time communicated is most prudent course.

But beyond dispute certain that for Gonorrhoea alone mercury not necessary.

And even to be doubted if useful.

Cure even more readily affected by much more simple medicines.

Which, it must be allowed no inconsiderable evidence, that two diseases from infected [mother] of nature essentially different.

And from all circumstances taken together cannot help thinking that the opinion is at least probable.

Am far from imagining however that what have now thrown out will by any means afford conviction.

Offer present observations rather as subject of future reflection.

And shall be glad if lead you to [examine] into facts with attention.

For is I apprehend by this means alone that present controversy can be finally determined.

Must however conclude as already demonstrated that from every view which have been able to take of this matter am inclined to consider the diseases as essentially different.

And on this opinion practice in instance before us proceeded.

Of this then next follows that should offer few observations.

And as shall not probably again see much of patient may now offer such remarks as are suggested

In this case before patient came under care disease had been nearly of fortnight standing.

By this therefore precluded from trial of such practices as might be supposed to operate either by dissolving mucus to which infected matter adhered, or by discharging it from increasing secretion.

At time of admission inflammatory stages of the disease might be considered as nearly about height.

Consider it therefore to be at first principle objective to mitigate this.

Symptoms however not to such a height as to demand in this way any very great evacuation

And apprehend that the more these can be avoided during inflammatory stage, the less danger is there of long continuation of atonia.

Was on this account that at first had neither recourse to bleeding nor purgatives.

But with enjoining antiphlogistic regimen directed merely as medicine the use of [illegible] & refrigerant.

With first intention employed powder of Nitre with Gum Arabic.

With last the infusion Linimentum

From these hoped in some measure to diminish general impetus of circulation.

Concluded however that would have still more affect as counteracting ardor urinae

And by this means would obviate most urgent symptom the strangury affection

For concluded that this solely affect of stimulation of urine on parts with augmented sensibility.

And expected diminishment from [sheathing] acrimony of urine by demulcent quality of Gum Arabic & Lint seed.

But still more from increasing the proportion of watery to saline part by introduction of diluents into system & by diuretic powers of nitre.

From these however did not reap all good effects which expected.

And continuation of inflammation such that at next visit reckoned it necessary to obtain depletion of system by cathartics.

With this view had recourse to one of refrigerant kind operation of which reckon most certain – the Salt Glauberi

From this with continuation of former course symptoms of inflammation soon disappeared.

And with continuation of no symptoms of any consequence but running considered atonic state of vessels to be great object of attention.

With view of restoring former vigour to secreting organs in urethra often powers of system themselves fully sufficient.

And unless where either in quantity [incessant] or runs on to great length necessary perhaps to do but little.

Where remedies are necessary many may be had recourse to.

And what reckon among most powerful of these are cold bathing & astringents [illegible]

Did not however look upon either to be requisite in case before us.

Had therefore recourse to one which may I apprehend be more frequently employed with safety that is Peruvian Bark

And which under proper administration not without very considerable affects.

To extent indeed to which here given could not expect very great benefits from it

But where exhibited early in disease [illegible] requisite that should be begun in spring [illegible]

For unquestionably some tendency to renew disposition to inflammation.

And in some particulars constituent running even so suddenly checked by this as to give rise to uneasy symptoms.

Particularly swelling of testicles.

On this account therefore began patient with use of it to extent of a ʒi. only every day.

Was however intention if circumstances should require or permit of it afterwards to increase quantity.

Cannot with great confidence affirm that had here any remarkably good affects.

But at least was product of no bad consequences.

And must own that disposed to refer to it diminishment of running which soon occurred.

Did not indeed uniformly continue in this state

Yet symptoms on the whole so far abated that in short time reckoned it unnecessary to continue his attendance.

And without very great [impediment] on his own part may now I apprehend consider no farther measures to be requisite.