Part 4
Different methods have been suggested to minimize the chances of venereal infection. One of them is the use of rubber protectors, “condom,” but the protection they give is far from certain, as they occasionally tear, and also the infection may be implanted in parts beyond the protected area.
The United States Army and Navy, as well as some European governments, have introduced some preventive ointments for syphilis and injections for gonorrhea, but these preventive measures to be effective must be applied at once after the exposure, and in a most thorough and careful manner.
VENEREAL DISEASES.
As mentioned before, there are three venereal diseases, which constitute the main bulk of venereal cases, and which are at the bottom and the cause of most venereal disorders. They are Gonorrhea, Syphilis, and Chancroid. These diseases are produced each by a different and separate kind of germ; they develop independently one from another, and they can never change one into another. But they can coexist in one patient; i. e., a man can get at the same time gonorrhea and Chancroid. If this double infection takes place, then both diseases have to be treated at the same time. The fact that a man has already one disease in a chronic form does not prevent him from getting another. Equally so, the fact that a man has already once had a venereal disease does not prevent him from contracting it a second time, nor does it make it less likely to occur. This is particularly true in the case of gonorrhea and Chancroid, but much less in syphilis, in which an infection for a second time is rather rare.
PROGNOSIS (PREDICTION AS TO THE FUTURE DEVELOPMENT) OF VENEREAL DISEASES.
The popular mind usually estimates the danger, seriousness, and probable duration of any disease by the amount and intensity of pains, by the violence and rapidity of its development, and by the degree of disability that the sickness inflicts on a man. Nothing could be farther from the truth than this belief in the case of general internal diseases, and still more in regard to venereal diseases. The most destructive, most malignant incurable diseases in most of the cases begin slowly, insidiously, without acute and severe pain, hardly attracting the attention of the patient, and for a long time not interfering at all, or very little, with his working capacity. Often the patient wakes up and takes notice of the disease only after it has gotten deeply into his system and holds him in its clutches, never to release him. On the other hand, many acute diseases, that start with a high fever, violent pains, and other alarming and terrifying symptoms to the patient, under intelligent care pass away just as quickly as they come, and leave the patient without any permanent damage. This is particularly true in regard to venereal diseases. _Do not judge the seriousness and dangerous nature of a venereal disease by the amount of pain and discomfort it brings to you._ In no other respect are the venereal patients as much misled and fooled as in this, and no other mistake brings as much unnecessary and preventable suffering and financial loss. Only a competent physician, after a careful observation and repeated examination with the special methods, can give a correct estimation as to the danger and probable duration of the disease.
Remember also that the best and most learned specialist cannot promise you a perfect cure in a specified time, but he can give you only a probable duration of the disease, liable to be changed by many unforeseen circumstances; and keep away from a man who “guarantees a sure cure” in so many weeks or months. The treatment of venereal diseases can never be forced and hurried thru in a certain period of time, and those patients who insist on a doctor’s pushing the treatment in forced marches always strike a bad bargain and are doomed to disappointment by a relapse of the disease or the development of serious complications.
GONORRHEA.
Gonorrhea, commonly termed a clap, is unquestionably the most widespread of venereal diseases. So common it is, so insidious and deceiving in its appearance, that most men fail to realize its serious and often dangerous nature and regard it as a trifling affection. How often one hears boys repeat this hackneyed and silly expression, “I would rather have a clap than a bad cold.” What childish recklessness, what arrogant ignorance, and how terribly it is punished and regretted later on!
The more medical and social workers study the clinical and social ravages produced by gonorrhea and its complications, the more they are impressed by its enormous and far-reaching destructive power on human health and happiness. It is a wellestablished opinion among the medical scientists at the present time that the total amount of damage and suffering to individuals and to society at large produced by gonorrhea falls not far below that produced by Syphilis, which is justly known as a black scourge of humanity. Gonorrhea is considered now a very serious disease, requiring, for a complete and permanent recovery, long and painstaking treatment. The complications of gonorrhea are numerous and far-reaching. _Ninety per cent of inborn blindness in children_ in institutions for the blind are _due to Gonorrhea_, and tens of thousands of little sightless victims are a pitiful evidence of the disastrous consequences following the neglect or indifferent handling of Gonorrhea cases. It is also known that possibly half of all operations performed on women are due to neglected or unrecognized cases of Gonorrhea, and thousands and thousands of young women become permanent invalids thru the ignorance or indifference of their husbands. Only a Genito-Urinary specialist, who sees how many of these cases are mistreated or untreated because they are regarded by the patients as trifling and not worthy of any particular attention, who sees how these cases, once the sickness takes deep roots in the body, drag on for months and months in spite of the best treatment; only a physician can realize to the full extent how seriously and carefully each case of Gonorrheal infection must be handled. The respect and fear of Gonorrhea comes to young men only after a sad and distressing experience as an afterthought. How much better it would be as a forethought. It is the writer’s hope that the following lines will serve as a torch of knowledge, shedding light and guiding to safety the traveler through the darkness and dangers of sex ignorance.
DIAGNOSIS (RECOGNITION OF GONORRHEA).
Gonorrhea is an inflammation of the lining of the urethral canal, produced by a certain kind of germ called _Gonococci_. These germs are so small that millions of them can be found in one drop of pus (matter), and they can be seen under a microscope grouped in pairs, and resembling in shape the halves of coffee beans put together. Gonorrhea is also called a _specific urethritis_, which means an inflammation of the urethra caused by a specific germ, to be distinguished from a _simple non-specific urethritis_, produced by other germs not Gonococci.
There is a great difference in seriousness and possibilities of developing various dangerous complications between real Gonorrhea, i. e., specific and simple non-specific urethritis. Simple urethritis is a mild and harmless catarrh of the urethra, which ordinarily clears up in from one to two weeks with a very simple treatment and even without treatment. Simple urethritis never leads to any deep or dangerous complications, never goes into the blood of the patient, and does not carry over affection to the wife and children. Unfortunately, from every hundred cases of urethritis, the majority of them, not less than ninety per cent, are real Gonorrhea, and the balance of ten cases are simple urethritis. For a man who has contracted a venereal affection of this character it is of greatest importance to determine whether his case is a simple urethritis or real Gonorrhea; but this is not as simple as could be desired, and as most of the patients believe it is. It is absolutely impossible to differentiate between real Gonorrhea and simple urethritis by the clinical appearance of the case or to estimate the seriousness and duration of the case by the visible symptoms, such as the amount of discharge, intensity of pains, etc. Not only the patient, but _even the physician can not establish the presence of Gonorrhea in the case without a microscopical examination_. A man who claims to be able to estimate the nature and seriousness of the case from the looks of things is either an ignoramus or impostor, or both.
CLINICAL COURSE OF AN ACUTE GONORRHEA.
The first signs of Gonorrhea usually appear not before two and not later than five days after unclean intercourse. This is the so-called _incubation period_—a period that differs in length in various diseases. The first thing that attracts the patient’s attention is a slight itching or tickling feeling and a sense of heat in the end of the penis. From twelve to twenty-four hours later a swelling is noticed at the opening of the urethral canal, and a whitish discharge begins to ooze from the canal. This discharge begins to increase rapidly in thickness and amount, and soon a greenish yellow thick pus begins to flow profusely. Correspondingly, the swelling and inflammation increase more and more, and urination becomes more difficult and painful, very often so agonizing that the patient holds the urine as long as he possibly can. _Usually it takes from one to two weeks until the sickness reaches its climax, then for a week or two it stands at the same height, and from the third or fourth week it begins to go down_, the discharge diminishes in amount, turns to creamy white, then becomes thinner, slimy, the urine becomes clearer and clearer, and _in five to six weeks from the beginning of the disease the patient recovers completely_. This is the course of a somewhat normal case of Gonorrhea, with smooth, regular development and without any complications. _A man must consider himself very lucky if he recovers from Gonorrhea in five to six weeks completely._ Only a small minority of all Gonorrhea cases run so smoothly, probably not more than 25 to 30 per cent. The majority of the cases, sometimes in spite of the best treatment and the best care, develop different complications, which increase the duration of the disease for a much longer period.
COMPLICATIONS OF GONORRHEA.
In the beginning of Gonorrhea the inflammation is limited to the front part of the urethral canal, but in many cases the inflammation goes in deeper and spreads to the rear part of the urethral canal nearer to the bladder.
DEEP GONORRHEA.
Acute deep Gonorrhea is usually brought about by some indiscretion on the part of the patient, such as violent physical exercise like running, jumping, dancing, or it may be also produced by drinking of alcoholic liquors or by strong and improperly done injections at the hands of self-doctoring patients. It develops usually from the third or fifth week from the beginning of the sickness. The first symptom of acute deep Gonorrhea is the increase in frequency and painful urination. The most characteristic feature is that the _pains are not felt in the beginning or during the act of urination, but right at the end of it_, due to spasmodic contractions of the deep urethral muscle on highly inflamed parts. Another distressing feature is the frequency and urgency of urination, so that the patient cannot hold back his urine for a moment, but has to void it immediately. One more symptom that often misleads the patient into the belief that he is getting better, while in reality the opposite is true, is a rather _sudden stoppage of the discharge_, which has been rather free. At the same time quite often a drop or two of bloody discharge appears at the close of urination, accompanied with the intense spasmodic pains mentioned above. This combination of symptoms makes the acute deep Gonorrhea a most distressing and alarming complication to the patient, and frequently he wakes up for the first time on this occasion to a full realization of the serious and dangerous nature of Gonorrhea. Acute deep Gonorrhea, under intelligent care, subsides and quiets down in two to three weeks, but for a complete cure it takes from six to eight weeks more, so that all together these cases take from two to three months. The importance of Acute Deep Gonorrhea lies mainly in the fact that it indicates that Gonorrhea Germs have penetrated deep into the system, opening a gateway for other deep and serious complications.
GONORRHEAL INFLAMMATION OF THE TESTICLE (EPIDIDYMITIS).
The nearest place for Gonorrheal germs to invade from the deep Urethra is that part of the testicle which consists of the twisted and folded on itself spermatic duct; this part is called the _Epididymis_, which means the _appendix of the testicle_. Epididymitis starts usually quite abruptly, from three to five weeks from the beginning, after some physical exertion, like too fast or too much walking, running, jumping, dancing, wrestling, etc. It starts with a high fever, headache, feeling of heat and weight, and agonizing pain in the testicle. Every motion and walking becomes impossible and the patient has to take to bed. The testicle in its rear part becomes swollen, sometimes to twice or even more its normal size, and hard. Under proper care, the acute symptoms of pain and swelling _subside in two to three weeks_ and the patient is able to resume his work, but a part of the swelling and hardness remains and can be felt for many, many months, until it gradually disappears thru slow absorption; yet in some cases a small, hard nodule remains forever. The main danger of Epididymitis is just in this very possibility, that the spermatic duct may be partially or completely obstructed and blocked permanently by the inflammation, in consequence of which no spermatozoa can go out from the testicle of this side, and _if Epididymitis occurs on both sides_, which happens often, then obliteration of the spermatic ducts is complete; in other words, _the man can never have children—he becomes sterile_.
GONORRHEAL BUBOES.
Among acute complications of Gonorrhea should be mentioned also buboes, very much dreaded by the patients, who are pleased to call them, for some reason, “blue balls.” Buboes are a swelling of the glands in the groin, which can be felt as hard and tender knots. Gonorrheal buboes are very harmless, usually go down promptly under treatment, and very seldom form an abscess.
CHRONIC GONORRHEA (GLEET).
_A case of Gonorrhea that lasts longer than three months is called chronic._ There is a number of different conditions that may keep Gonorrhea up for many months and even years. Chronic Gonorrhea differs from acute by the absence of pains, swelling, or any other violent or acute symptom. The discharge is either very slight, just a drop in the morning (so-called _good morning drop_) or none at all. Frequently a man feels no discomfort of any kind and does not notice anything abnormal, except possibly a slight pasting and glueing of the urethral canal, in which cases only a close examination of the urine will show that it is full of shreds; but a large majority of the cases of chronic Gonorrhea is accompanied with more or less copious discharge, commonly called Gleet.
Chronic Gonorrhea may be limited either to the front part of the Urethra or to the deep rear part.
PROSTATITIS (GONORRHEAL INFLAMMATION OF THE PROSTATE GLAND).
A most frequent cause of Chronic Gonorrhea is the extension of the Gonorrheal infection into the Prostate Gland, which, as mentioned above, lies deep between the Urethra and the bladder. Once Gonococci have penetrated into the deep recesses of the Prostate Gland, they secure there a very strong foothold, and it is very hard to reach and dislodge them with an ordinary treatment. Gonococci may lay dormant in the Prostate Gland, producing very few active symptoms and very little annoyance and discomfort to the patient, who may consider himself well, or pretty near well, and suddenly, after some indiscretion like dancing or use of alcoholic liquors, the germs take a new lease of life and precipitate an acute outbreak of Gonorrhea. The patients as a rule believe that they have contracted a fresh case, while in reality it is a case of reinfection from their own prostate gland. These cases of rekindling of old Gonorrheal prostatitis can repeat themselves many, many times, until the true cause is discovered, and the Prostate Gland is cleaned up thoroughly.
A chronic Gonorrheal Prostatitis is an extremely common infection. Probably not less than half of the Chronic Gonorrhea cases are due to the involvement of the Prostate Gland. The tissue of the Prostate Gland is extremely rich in nerves, and its chronic inflammation, thru the pressure and irritation of different nerve endings, produces pains and discomfort, not only locally in the genital organs, but also far away in different parts of the body. Locally, the _symptoms of chronic prostatitis are a whitish, milky discharge from the urethral canal_, particularly _after urination or defecation_ (stool), and _a deeply-seated feeling of weight or deep burnings_. From distant pains produced by the irritation of the nerve endings, most common are pains in the legs, in the back, in the region of the stomach, and headaches. In fact, very often patients come complaining of pains in different parts of the body, without having the slightest suspicion that the cause of it all is their infected Prostate Gland. One of the most distressing features of chronic Gonorrhea prostatitis is its powerful, depressing influence on the patient’s spirit and mentality. No other complication of Gonorrhea wears down a man’s courage, self-assertiveness, and joy of life, none of them makes a patient so disheartened, worried, and despairing of recovery as does chronic Prostatitis. Gonorrheal Prostatitis, under the best treatment, takes usually several months for a complete cure, and the task to keep up a patient’s courage and confidence in his recovery taxes as much the physician’s skill as the treatment itself.
GONORRHEAL STRICTURES.
Next to Gonorrheal Prostatitis in frequency and practical importance should be mentioned stricture. In fact, in many cases it is much more dangerous, as the old neglected stricture can never be cured completely, while prostatitis, even in the old cases, almost always can be brought to a satisfactory condition.
The stricture is a scar, forming gradually and slowly after an uncured Gonorrhea. Usually these scars are a result of row patches in the urethral canal that quite frequently develop during a chronic Gonorrhea. These patches, so-called _granulation patches_, what the public calls “wild flesh,” are a common source of pains and persistent discharge, lasting for many months. These granulation patches can be discovered only thru a special instrument called _urethroscope_, which introduces electric light in the urethral canal and makes possible a clear and exact inspection of its entire surface. If these patches are not discovered or not properly treated, they may heal up slowly by themselves, but not in a natural way with the restoration of the normal size and smooth lining of the canal. They will heal up with a scar that has a peculiar ability to shrink and to contract. As a result of it, the normal (lumen) channel of the urethral canal is interrupted, twisted, and obstructed, partially or completely, which leads to a retention or a stoppage of urine. The granulation patches are soft in the beginning, and can be cured without difficulty in very few weeks or months; but after they have turned into a stricture the treatment is immeasurably harder and longer. In fact, the _very old strictures cannot be cured completely, but only relieved temporarily_.
The main danger of a stricture is its slow and insidious development. It takes many months for a granulating patch to turn into a fresh stricture, and it takes years to form an old stricture. For months and years a patient may have no discomfort nor symptoms sufficient to call his attention to his condition, and by the time he begins to feel some annoyance and to notice some disturbance, the stricture is already old and incurable. Therefore it is highly important for any man who has had the misfortune to contract Gonorrhea to secure a positive assurance that he is in no danger of developing a stricture later. The active symptoms of stricture are: (Gleet), a _slimy discharge, particularly in the morning; frequency of urination and a slow, dribbling, weak stream of urine_; but, as mentioned above, these symptoms develop long after the stricture is formed, and no man should wait for their development.
GONORRHEAL RHEUMATISM.
The last, and by no means a rare complication of Gonorrhea, is rheumatism. Gonorrheal Rheumatism usually sets in abruptly at any time in the course of disease, and commonly attacks ankle, wrist, knee, or elbow joints. Clinically, it strikingly resembles a common acute rheumatism, but the treatment which is efficacious for the common variety of rheumatism is perfectly useless in Gonorrheal. Gonorrheal Rheumatism is a very serious complication; it causes a good deal of suffering, it takes many weeks or months for a complete recovery, and in many cases leaves behind stiff joints and permanent disability.
TREATMENT OF GONORRHEA.
We shall proceed now to describe briefly the general principles and methods of the treatment of Gonorrhea and its complications, as we believe that the intelligent understanding of these methods will help men afflicted with Gonorrhea to avoid blunders of self-doctoring and exploitation by ignorant impostors and unscrupulous medical quacks. The acquaintance with scientific methods of treatment of Gonorrhea considered the best at the present time should prove conclusively to these men that to protect themselves against dangerous complications and permanent injurious aftereffects of Gonorrhea, they should not trust their health either to friends ever ready with advice nor to the alluring and highsounding promises of quacks; it would show that _there is no short cut to a cure of Gonorrhea_; that this cure can be effected only by systematic and persistent treatment at the hands of a competent physician.
The first point of importance to remember in the treatment of Gonorrhea is that Gonorrhea is essentially a local disease, and that it penetrates into the blood in the whole system very seldom; in fact, only in one complication, Gonorrheal Rheumatism. This fact readily explains why the _main treatment of Gonorrhea is local_, and why the internal treatment with drugs is of secondary importance, and in many cases can be omitted altogether. Yet the public at large seems to believe as religiously as ever in the magic power of different potent drugs, such as “blue” capsules, cubeba, copaive balsams, santal oil, etc. This medical superstition unfortunately is encouraged and kept up by manufacturers and dispensers of these drugs for commercial reasons, as well as by many healers disqualified by the law or the lack of special training and equipment.
TREATMENT OF ACUTE GONORRHEA.