ed them, in cultivating the study of a class of maladies whose protean forms have so long defied the penetration of the most acute and diligent investigations, and around which still hangs a cloud of comparative obscurity and mystery.

CONSIDERABLE perplexity and confusion have been caused both by British and continental writers in the description of this disease, and the stages into which each, according to his peculiar ideas, deemed prudent to divide it. I have therefore made choice of the following classification, which in my mind possesses the advantage of being at once simple, intelligible, and practical.

Gonorrhoea may be arranged under two general heads -I. External or preputial; II. Internal or urethral. Internal or urethral gonorrhoea may be again divided into, first, simple inflammatory; second, purulent; third, complicated.

1. External or preputial gonorraha. This affection is usually met with in individuals the subjects of natural phymosis, and arises in consequence of the existence of inflammation of a more or less

*I have employed this term, although objectionable as being the one most familiar to English readers.

acute nature between the glans penis and internal surface of the prepuce. It may be excited by connexion with a female labouring under simple inflammation of the vagina, a gonorrheal or leucorrhoeal discharge, and not unfrequently is the result of sexual intercourse during the menstrual period. The secretion of the glandulæ odoriferæ, when over-abundant and irritating, has been known to occasion a mild species of this affection, without exposure to infection from sexual causes. A striking example of an inveterate form of the disease, from the last named cause, came under my observation a short time since.

Case. Whilst on a visit in the north of Ireland, I was consulted by a clergyman, the subject of natural phymosis, and of unusually active habits, for the relief of symptoms of so distressing a nature as to prevent him officiating, in accordance with previous arrangements, in his church upon that day, Sunday. Being desirous of reaching home before the appointed time, he was compelled to ride on horseback for nearly twelve consecutive hours, over a mountainous and rugged country; during which period he was exposed to the inconvenience resulting from heavy and repeated showers, and also that consequent upon wearing buck-skin trousers, the unyielding nature of which caused him a considerable degree of uneasiness, arising from the undue friction occasioned by them. Upon examination, the penis presented a swollen and distorted

appearance, and the veins of the prepuce were enormously distended. From the height to which inflammatory symptoms had attained, it was found impossible to denude the glans; and the preputial opening, from which issued a muco-purulent discharge, was contracted to the size of a pin's head. By persevering in the treatment hereafter described, all unpleasant symptoms disappeared, and a cure was effected in about three weeks.

A sensation of heat and itching in the glans penis is usually the prelude to an attack of this nature. This is quickly followed by a patchy redness, which engages the glans and inner surface of the prepuce. A discharge of muco-purulent matter, of an offensive odour, is next observed to issue from the contracted orifice of the prepuce ; the inner surface of which, in common with that of the glans, is covered by a peculiar tenacious curdy matter. A similar train of symptoms, however, to those described, may ensue from inflammation, the consequence of an ulcer situated either on the glans or prepuce; but in this case a direct diagnosis may be arrived at by pressing the penis between the fingers, when a morbid tenderness is complained of, and a sensation of circumscribed induration is usually conveyed to the touch of the operator. When no ulcers are situated beneath the prepuce, the disease may be treated as a purely local affection, and a favourable prognosis may be given. If inflammation run high, so as to preclude the possibility of

denuding the glans, warm fomentations, which should likewise be injected beneath the prepuce, will be found most grateful to the patient. This mode of treatment possesses the two-fold advantage of soothing irritation, and loosening any adhesions which may have set up between the glans and prepuce. If pain be much complained of, an aqueous solution of opium, or decoction of poppy heads, may be substituted with decided benefit. When the redness and swelling partially subside, a solution of nitrate of silver, in the proportion of ten grains to the ounce, may be thrown in occasionally between the glans and prepuce, and the penis may be enveloped with compresses saturated with a cold evaporating lotion.

Sympathetic irritation is sometimes so great as to give rise to considerable pain and uneasiness in the groin; in this case, a few leeches applied to that particular region seldom fail in affording relief. Rest in the recumbent position should, during the first few days of the attack, be enjoined, and the secretions from the bowels should be particularly attended to. I have occasionally observed enlargement of the inguinal glands succeed to this form of gonorrhoea; but I do not remember having ever met with suppuration in the groin, where ulcers did not previously exist.

It has been frequently affirmed, that in neglected cases the accumulation of matter beneath the prepuce may give rise to chancres, which may lay the