Part 5
The very first request a gonorrheal patient addresses to a physician is to stop the discharge as soon as he can. Should the physician comply with this request, he would show by doing so not only a complete ignorance of the subject, but he would also do a great deal of harm to the patient himself by driving the disease inside instead of outside. The popular fear of a discharge is based on the ignorance of the fact that the discharge in Gonorrhea, like many other symptoms, such as fever, cough, vomiting, etc., in other diseases, are not harmful by themselves, and that in a certain stage of the disease they serve a useful purpose of helping the human body to get rid of the different poisons and disease-producing germs. So in Gonorrhea the thick, greenish yellow discharge helps along the Nature to throw off and to eliminate Gonococci, and until this purpose is accomplished, to check a discharge is not only unnecessary, but absolutely harmful. Therefore, _in the early stage of Gonorrhea_ intelligent treatment calls for injection with antiseptic drugs that kill Gonococci and rather _stimulate a discharge than check it_. Only later, in from three to four weeks, when the character of the discharge shows that all Gonococci are already eliminated, and that therefore the discharge has outlived its usefulness, only then the physician is justified in giving injections with the binding or astringent drugs, that check and gradually stop the discharge.
Ignorance or a deliberate violation of this rule in a foolhardy attempt to make a short cut to a cure has caused, in thousands and thousands of cases, a penetration of Gonorrhea into the deeper organs and has led to numberless complications and injurious aftereffects.
_The injections_ can be started usually at once, with the exception of the few very acute cases, where the swelling and pains are so severe that it is necessary to wait a few days before starting the injections. It is in these cases particularly that the use of the internal drugs, usually mild antiseptics, is advisable until local treatment can be started. In making injections, one point should never be overlooked: this is, to _urinate each time before making an injection_; failure to do this has driven many gonorrheas into the deeper parts.
DIET AND A GENERAL REGIME IN GONORRHEA.
The dietetic and general regime in an acute Gonorrhea is just as important as the medical treatment. In the _first three to four weeks as much rest and quiet as a patient can possibly secure_ is a very important condition to prevent injurious complications. Too much or too fast walking, running, jumping, dancing, wrestling, etc., should be absolutely prohibited. A well-fitting suspensory bandage should be put on at once. That alcoholic liquors are tabooed is pretty well known to the public, except a very few tyros that still believe that beer can drive out the disease. All stimulating drinks, like coffee, chocolate, strong tea, and sharp seasoned food should be avoided until the acute stage is over. Drinking of plenty of plain water should be encouraged, as the resulting copious urine provides a natural and most efficient drainage and elimination of the dirt of the urethral canal. Less meat and more milk and cereals is the best diet for an acute stage of Gonorrhea. There is no objection to moderate smoking. It stands to reason that any sexual excitement or stimulation is extremely harmful and aggravates the condition immensely. Absolute cleanliness must be insisted upon, and the patient must be careful not to spread the disease by soiling with gonorrheal discharge different articles of personal use that may be used by others. He must be careful also not to carry over a gonorrheal poison with the soiled fingers into his own eyes, as _gonorrhea of the eye is a most dangerous disease_ that often leads to complete blindness.
TREATMENT OF GONORRHEAL COMPLICATIONS.
The closing stage of acute Gonorrhea is the only time when a patient can be allowed to take a part in the treatment by making injections at home after careful and personal instruction by a physician. All the rest of the course of Gonorrhea and its various complications can be handled by a physician only, as it requires a special equipment and a special technic.
Deep gonorrheal inflammation forbids any instrumental treatment. With the first symptoms pointing to its development, all injections must stop until the acute stage is over. The patient is advised to rest, and is given some soothing internal medicine. After two or three weeks the local treatment may be resumed.
Similarly to it is treated Acute Epididymitis (inflammation of the testicle). With the first signs of its development, all injections must stop, and the patient has to stay in bed until all acute swelling and pains are gone, which takes usually from two to three weeks. Locally, cold in the form of ice bags, or heat with the hot-water bottle, are used. They are both good, but in either case the applications have to be kept up persistently. Their selection depends upon individual preference and feeling of relief experienced by the patient. Locally, different ointments are used to reduce and soften the swelling.
Deep Gonorrhea can be cured only by deep injections, with a special instrument called _instillator_, of a few drops at a time of strong germicide drugs.
Extremely useful also and commonly used are _irrigations_ with a fountain syringe of large quantities of antiseptic and soothing solutions, which fill up the bladder and effect a thorough flushing of the whole urethral canal. These irrigations are used under most variable conditions, and are often used preceding or concluding instrumental treatment. Their efficacy depends on the systematic and persistent use and a careful and exact grading of the strength of the solutions.
_Granulating patches_ or row spots mentioned above as the source and origin of strictures can be _treated_ only by _the urethroscope_ described before, by localizing them and touching them up with cauterizing medicines. This treatment is supplemented by _stretching with the steel sounds_ and irrigations. The _treatment of strictures_ is very similar to this, and mainly consists of _stretching_ with gradually increasing in size _sounds and irrigations_.
Finally, _Prostatitis is treated mainly by massage of the prostrate gland_, which is done by a finger inserted per rectum. This massage, made once or twice a week, is one of the most valuable parts of the treatment of chronic Gonorrhea, because in no other way can pus and gonococci be eliminated and carried out from the deep recesses of the gland as thru massage. Prostatic massage is usually followed by instillations or irrigations.
PROGNOSIS (PROBABLE DURATION AND CURABILITY OF GONORRHEA).
_Treatment of all deep chronic complications of Gonorrhea takes usually from two to six months_, and sometimes longer if the case is neglected. Patience and persistence in treatment is an absolutely indispensable condition for success, and patients who take treatment for a while and then drop it because, in their opinion, their case is incurable are throwing away their only chance of cure. The fact of the matter is that chronic Gonorrhea, if treated properly and patiently, can be considered a thoroughly curable disease. The incurable cases make up not more than 5–10% of the total number of cases properly treated, and these few exceptions are usually neglected old strictures, which of all Gonorrheal complications are the hardest to cure.
GONORRHEA AND MARRIAGE.
After the treatment of chronic Gonorrhea is completed; after all visible signs and symptoms have cleared up; after the patient has resumed, with the permission of his physician, his usual mode of life, a momentous question comes up before the patient—when can he marry with an absolute assurance that he will not transmit his sickness to his wife; in other words, when can it be stated that he is absolutely cured? That the answer on this question may mean happiness or misery in life for the patient is realized and recognized by all intelligent people. But it seems to be unknown and commonly overlooked that to give a positive and definite answer to this question is a matter of great responsibility and of greatest difficulty, even to the most experienced and highly-trained specialist. Only those who know how treacherous are gonococci, what ability they have to lie dormant for many months or even years in the deep recesses of the body and then on some provocation to waken up to new activity, only those know how hard it is to get the system rid of them, and how difficult it is to be sure of their complete elimination. And yet almost in all cases a physician is able to tell with reasonable certainty whether the patient is able to get married without danger of transmitting the infection, but to arrive at such a definite conclusion a physician must undertake a whole series of different examinations and special tests, as only repeated, persistent, negative tests for Gonococci can be accepted as conclusive. A man who comes to a physician and insists that the physician should render his verdict at once demands the impossible, and the hasty conclusion he will force out is not worth much.
URINALYSIS (EXAMINATION OF THE URINE).
The first step in a series of examinations to form an idea of the localization, intensity of gonorrheal infection and to gauge the results accomplished by the treatment is an examination of the urine. Even a plain inspection of the urine gives to the experienced eye of the physician a pretty good idea of the localization and intensity of the case. To get the best results, the patient must call early in the morning with the very first urine kept in the bladder over night, for the reason that the frequent voiding of urine during the day continually washes out the secretion, and thus masks the true picture of the sickness. The physician inspects the urine after it has been voided in two or three glasses—so-called _two and three glasses test_.
A systematic and repeated examination of the urine is one of the most important and healthful procedures in the treatment of Gonorrhea, and no intelligent physician can do without it. In this regard, a word of warning should be addressed to the gonorrheal patients. Let no one fall into the error of playing physician in his own case and try to look at his own urine at home, drawing his own conclusions. This is surely one of the occasions where a little knowledge is worse than none. No matter how intelligent a patient may be in other respects, his attempts to gauge his condition by the appearance of his urine will end disastrously in blunders, causing unnecessary worry and striking terror into his heart without reason.
Among the most common mistakes of this character is to regard the long shreds swimming in the urine for pieces of tissue which come, they imagine, from their decaying organs, while the shreds are nothing but the harmless mucous so-called _gonorrheal threads_, and the longer these shreds are and the more terrifying they appear to the patient the more harmless they are.
Another common and unnecessary scare is due to a cloudy, dirty-looking urine, often full of _sandy-like sediment_ which in reality is not a result of the sickness, but is produced by harmless salts from certain food or drugs. These two examples should be sufficient to show that for the best interests of the patient the interpretations of the symptoms of the disease should never be attempted by themselves, but should be left entirely to the physician.
The next step after the inspection of the urine is a _microscopical examination of the discharge or a sediment from a urine_. This test is the _most significant of all_. If a physician finds under the microscope typical gonococci even once from so many times, the patient cannot be pronounced cured and free from infection, no matter how well he feels and how successful are all other tests.
If a microscopical examination of the discharge and of the sediment of the urine is negative, i. e., gonococci are not found, then the physician must secure thru massage a _secretion of the prostrate gland_ and seminal vesicles and _examine_ these fluids _under a microscope for gonococci_. Even this is not sufficient, and the search for hidden gonococci can be made still more effective by a _bacteriological test_, which consists of producing an artificial growth of gonococci from a discharge. This test is extremely sensitive, but it is complicated. To assure still greater positiveness of the judgment, a so-called _provocative test_ can be used. The patient is allowed not only to return to his normal mode of life and unrestricted regime, but for experiment’s sake is even allowed an excessive indulgence in stimulating food and drink. Here should be mentioned the so-called “beer test,” which is based on the fact that beer has a peculiar irritating and stimulating influence on gonococci, bringing them from the deep recesses to the surface, where they can be easily found on microscopical examination.
If all these tests are uniformly negative, then the patient can consider himself cured and free from infection, and can be allowed to marry. But _if a single one of these tests are positive, that is, shows the presence of gonococci, and the rest of the tests are negative, then the case is still under suspicion and requires further watching or treatment_.
It is proper to state, tho, that in certain cases a man may be allowed to marry even before he is perfectly cured from all after-results or complications of Gonorrhea. This is particularly true in regard to strictures, chronic prostatitis, or hard nodules remaining in the testicles after Epididymitis. The reason for this allowance is that the contagious stage of Gonorrhea does not last always thruout the whole course of the disease. Quite often the gonococci are dying out before the after-results and different inflammatory conditions (that were originally started by gonococci, but later were kept up by other germs always present in the genito-urinary tract) are cured. Therefore if a physician, after having tried all the above-described tests, is satisfied that there are no more gonococci present and detectable, and that the condition as yet uncured, such, for example, as a stricture which carries no germs and precludes every possibility of transmitting infection, then he can conscientiously allow the patient to get married, if marriage, for some personal reasons, can not be delayed. At the present stage of medical science the tests establishing the fact of perfect cure of Gonorrhea is a time-consuming and complicated procedure, but considering the responsibility involved both for the patient and the physician, no intelligent man should fail to go through it, if it should fall to his lot to do so.
Functional Sexual Diseases.
After briefly reviewing the problem of Gonorrhea in its different aspects, we shall discuss certain conditions which stand in very near relation to Gonorrhea. There are: _Impotence_, known under the common name of loss of manhood; _sterility_, loss of procreative power; and _sexual neurasthenia_, nervous debility developed on sexual ground. While these conditions may also develop independently without any Gonorrhea in the history, from other abuses and irregularities in the sexual sphere, yet in a very large number of cases they do develop, if not because of Gonorrhea, at least after it; in other words, Gonorrhea, by weakening general and specially sexual nervous apparatus, creates a certain predisposition for their development.
These diseases are worthy of serious consideration, as they are very widespread and are the cause of many unhappy homes, of untold family tragedies, and of much individual and moral suffering. These diseases do not cause physical pains, neither are they dangerous to life, but men afflicted with them feel so miserable, suffer such agonies of moral anguish, are so depressed in spirit and so despaired of life that they would prefer any acute pain or welcome any operation to relieve their misery.
IMPOTENCE.
Impotence, as mentioned above, is an inability to perform a normal sexual intercourse. The indispensable physical condition for a normal sexual intercourse is an erect position (erection of the penis) and a normal period of time before a seminal ejaculation takes place; hence Impotentia can be manifested either by partial or total power of erection, or premature ejaculation, or both. According to various causes leading to loss of erective power, three various kinds of Impotence should be considered—psychic, irritable, and paralytic.
_Psychic impotence_ is a very peculiar condition strikingly illustrating a powerful influence of the mind over bodily functions. It usually attacks young men in perfect health who are of a worrying and brooding disposition, particularly so over sexual matters. They may have on their conscience the guilt of having indulged in masturbation years ago, or they may have had a gonorrheal infection some time before. As a result of this brooding over the sins of their youth, they work themselves into a suggestion that they have ruined their system and have lost their sexual power, and such is the power of self-suggestion that in spite of perfect health and the absence of any abnormal condition, all attempts at normal intercourse end in dismal failure, which in the case of newly-married people is naturally a very grave and distressing occurrence. Ordinarily these cases get well after a certain period of time under the influence and care of a physician without any local treatment, but under general tonic regime. The main danger of these cases is that this class of cases fall particularly easy prey to medical quack healers, who exploit the ignorant and terror-stricken victims to the limit of their ability to pay, by intensifying their fear and curing them from non-existing terrible diseases.
IRRITATIVE IMPOTENCE.
The second type of _Impotence_, _irritative_, is the most frequent of all. In this condition the power of erection may or may not be affected, but the main distressing feature is a _premature ejaculation of seminal fluid_, which may take place even before a man approaches the woman. This condition is caused by over-stimulation and over-irritation of the sexual nervous apparatus, and is mostly the result either of an old habit of masturbation (self-abuse) or a chronic inflammation in the deep urethra left after previous Gonorrhea. This class of patients is also suffering from _frequent night emissions_ and _general nervosity_. They constitute the most pitiful and miserable group of all venereal cases. Weak and haggard-looking from loss of seminal fluid, broken in spirit as well as in body, they are haunted by a feeling of despair and utter annihilation; they are full of disgust with themselves, and are frequently incapable of pursuing their occupation. This class of men, as all the Impotentia cases, also fall easy prey to medical quacks, as they are often ashamed to go to a regular practitioner and family physician, and prefer to go to a stranger. Fortunately these cases are not difficult to cure, though it takes usually several months to effect a permanent cure. The treatment will vary according to the cause producing this hyperirritability of the nervous apparatus. It may require treatment of the deep urethra, prostate gland, or general tonic regime.
SPERMATORRHEA (INVOLUNTARY LOSS OF SEMINAL FLUID).
A common and one of the most distressing features of irritative impotence is _Spermatorrhea_, i. e., an involuntary loss of the seminal fluid, outside of night emissions. These seminal losses occur either as periodical oozing of a few drops at the end of urination and defecation, or as continual oozing as a result of muscular weakness and insufficient contraction of prostatic ducts. This continually oozing fluid is usually prostatic secretion, and is due to the existing chronic prostatitis. The cure of this condition is effected thru the treatment of the prostate gland.
URORRHEA (WETNESS FROM DRIBBLING AND OOZING OF CLEAR WATERY DISCHARGE).
It should be mentioned here that there is another condition resembling very much the above-described Spermatorrhea, a condition that scares the patients very much, who think they are suffering from seminal losses. This condition, Urorrhea, is very harmless, as the secretion oozing in these cases is plain water and mucus, due to excessive blood congestion in time of sexual excitement. But the difference between these two fluids and two conditions can be established only by a physician on microscopical examination, and should not be left to the judgment of the patient himself.
PARALYTIC IMPOTENCE.
The last variety of impotence, Paralytic, presents a condition opposite that just described, and instead of irritation and over-stimulation of the nervous sexual apparatus, it shows its weakness and exhaustion down to complete paralysis.
It is understood that every man reaching a certain age gradually declines in vigor of sexual power. This age of sexual decline varies considerably with different people, from the ages of 45–70, depending on general health, and still more on the mode of life. This much is sure: that _men who have led a regular and moderate sexual life and have married early retain their sexual power a good deal longer than men who have dissipated and indulged in various excesses_.
Paralytic impotence may mean either complete loss of erection or partial. Most common causes of paralytic impotence in young men are a persistent and excessive masturbation habit and excessive sexual indulgence. The earlier in life these vicious habits and excesses are started and the longer they last, the harder and harder is the cure of the resulting sexual exhausting impotence. In fact, these cases are the most difficult of all to cure, and many of them are incurable. Men suffering with paralytic impotence present a truly pitiful picture. They lose every ambition in life, lose their energy and force of personality, lose mental and physical vigor and endurance, and become mere wrecks and shadows of their old selves. If boys and young men could only see these victims of their own ignorance and folly as the physician sees them in their desperate and hopeless fight to regain their lost manhood, surely thousands and thousands of young, happy lives could be saved to themselves and to society.
The treatment consists in general and local tonic treatment.
STERILITY (INABILITY TO HAVE CHILDREN).
The foundation of society is a happy family and home life. The foundation of a happy home life is children. No home can be happy without the sunshine of the little ones, who are the dearest gifts of Nature to mankind. No marriage can be happy unless it fulfills its natural mission and reaches its full fruition by perpetuating the race of the parents thru children. The children are the greatest and most powerful incentive and inspiration for a man to work and to strive for a greater success in his chosen line. Children are a life mission and a life interest of a woman; they are the strongest and purest bonds of love between a man and a woman. Gloom and emptiness prevail in a home that is not blessed with children; there is no living interest and no natural attraction in such a home, and a childless couple is doomed to seek outside distractions and interests to fill up the natural void in their existence and to forget their heart-hunger.