Part 6
No man who looks forward to a happy family life in the future can ignore the question and shirk the responsibility of producing healthy children. And yet so many men, thru light-mindedness or ignorance in younger years, are responsible for the tragedy of a barren home later in life, when it is too late to retrace their steps and to redeem their sins of youth. Public opinion commonly puts the blame on the woman for being childless, and only in exceptional cases considers the possibility of the man being responsible for it. How unjust and how far from the truth! The inability to bear children, medically known as _sterility_, in a very large number of cases, at least half, is directly or indirectly due to a man’s disease or an inborn defect. Leaving aside a rather small group of cases, where a woman is unable to bear children due to some inborn defect or disease, the largest class of cases of sterility is due to venereal poisons, Gonorrhea, or Syphilis contracted from their husbands. In Gonorrhea, due to chronic inflammation of organs of procreation or mutilating operations—necessary in these cases—no conception is possible. In Syphilis, conception is possible, but a woman is unable to bear living children.
In the cases of direct _male sterility_, the woman is perfectly healthy, and the fault lies with the man alone. It may be due either to some inborn anatomical defect, or, what is infinitely more common, to some venereal disease. In these cases, the male embryos-spermatozoa are either absent or unable to travel in normal channels and to penetrate in the female organs. This inability may be due to a different cause; _the most common cause_ of all is Gonorrhea, or, more exactly, a _gonorrheal epididymitis_. As mentioned above, Epididymitis, if uncured, often leaves behind hard nodules which obliterate and obstruct the spermatic channel, partially or completely, thus blocking and preventing spermatozoa from passing from the testicles, where they are produced thru the urethral canal out of the body. A man who has had Epididymitis, with the complete obstruction of the spermatic channel only on one side, may yet have children, but if the obstruction is on both sides, he becomes absolutely sterile.
Another cause of male sterility, tho not as common, are strictures, which, by obstructing and twisting the urethral canal, may divert or weaken ejaculation of spermatozoa in such a way as to make conception impossible. It may happen also that tho all channels for the passage of spermatozoa are free, the spermatozoa themselves, due to a sexual or general exhaustion, are either missing or are of such low vitality as to give no hopes for living or healthy children.
Every man with a history of a venereal disease should have his seminal secretion examined under microscope before his marriage, to test its vitality. The knowledge of these facts and the application of these principles in practical life by the average man could save thousands of happy homes and prevent as many divorces.
SEXUAL NEURASTHENIA.
The last complication to be developed in the course of Gonorrhea, but not by any means the last in importance, is sexual neurasthenia; i. e., a chronic state of nervous and mental weakness and irritability. Possibly no other condition illustrates so well how far and deep-reaching is the influence of Gonorrhea on the whole system, tho it is a local disease; how thoroughly it affects the entire mental and nervous system of a man; how much moral anguish and suffering it inflicts on its victims. The reason for such a powerful effect of Gonorrhea on the human mind and emotions has been explained before by the fact that the genito-urinary tract and different sexual glands which are usually affected by Gonorrhea are richly supplied with nerves and are most intimately and abundantly connected thru these nerves with the highest centers of the nervous system, controlling the mental and emotional activities.
It has been mentioned already that the nervous weakness can be brought about by various sexual abuses and irregularities, such as the masturbation habit, sexual excesses, or over-stimulated and ungratified desire, but the cases following in the wake of chronic Gonorrhea and its complications are so numerous, so persistent, and distressing as to deserve special prominence and consideration.
Sexual Neurasthenia develops as a rule slowly, and it comes either during the treatment or long after Gonorrhea has been cured. The predisposition to this condition is created by excessive worrying and brooding over the disease, and the basis of sexual Neurasthenia constitutes an idea slowly formed and fixed in the mind of the patient that he is “full of disease,” and that his condition is incurable. As a result of this self-suggestion and constant concentration of his mind on different parts of the body, he feels, or rather he thinks he feels, an endless variety of different painful and morbid sensations. There is not a single spot on his body, there is not a single kind of pain or discomfort that should not be complained of by this class of patients. It does not matter whether his case is improving or even cured and does not show a single positive symptom of the disease, the patient cannot be won over to the cheerful view of his condition. No amount of argument or persuasion on the part of the physician avails to shake off his gloom and despair. If the physician, after a careful examination, states to a sexual neurasthenic that he does not need any more treatment, the patient accuses the physician of being indifferent, and not taking sufficient interest in his case and goes elsewhere. If the physician yields to the pleadings of the patient and keeps up an active treatment, that makes matters only worse, and still more confirms the patient of the deep and dangerous character of his condition. The only way to break the eternal chain of fear and anxiety, which is the main basis of sexual neurasthenia, is to turn the mind of the patient away from his sickness by stopping treatment, sending him away, if possible, from old associations and surroundings, and by building up his general and nervous system. The treatment of this condition lasts several months, but they all recover in due course of time.
This class of patients, in their frantic search for a cure from the imaginary sickness, are naturally more exposed to the danger of drifting away into the hands of medical quacks, and are more exploited than any other class of venereal patients. A sympathetic attitude on the part of the physician and evidence of his sincere and earnest interest in the condition of the patient is the only thing that slowly gains the confidence of sexual neurasthenics, brings them back courage, ease of mind, and restores them to a healthy and happy life.
Chancroid
Now before going over the greatest of all venereal scourges, Syphilis, we shall briefly consider the third and the least dangerous of the venereal diseases—Chancroid.
Chancroid is also called a _soft chancre_, to differentiate it from _hard chancre_, which is the initial sore of Syphilis.
_Chancroid usually appears from two to five days after exposure_, seldom longer. It may develop on the skin of any part of the sexual organs. It starts as a small red spot or pimple, which rapidly breaks down and forms a round ulcer, painful on touch, with undermined borders and profusely secreting pus surface. Chancroid may start at once as a multiple ulcer or it may grow in numbers after it has started as a single sore. The number of Chancroids may reach five, ten, or even more. The peculiar characteristic of Chancroid is that its poison can be transferred from one place to another by contact, and it is a common clinical fact, particularly in uncleanly and careless people, that a single Chancroid or ulcer may duplicate itself on the skin surface that comes in contact with the Chancroid.
_Chancroid is usually painful_ and disables a man to a smaller or greater extent, so for this reason it is seldom neglected. Under proper care, Chancroid _heals up in from three to six weeks_. Only in exceptional cases, due to low vitality and general debility of the patient, or due to unusual virulence (intensity) of the Chancroidal poison, the Chancroidal ulcer assumes a gangrenous character, and in spite of the best treatment, shows a tendency to spread and to destroy a large area of tissue. But even in these rare cases, after a few weeks or months, the ulcerated area gradually heals up without leaving any permanent systemic damage.
The only complication Chancroid has is a development of bubo, an abscess of inguinal (groin) glands. _Buboes_ develop in about half the Chancroidal cases, and are treated by incision on general surgical principles. The average duration of a bubo is from three to four weeks, and the total duration of the average Chancroid and bubo from six to eight weeks.
While Chancroid brings more pain and distress and disables a patient more than many Gonorrheal complications and average Syphilitic cases, in reality, Chancroid is the least harmful of all venereal diseases, as it has a self-limited duration, never penetrates into the blood, does not lead to any deep or constitutional complication, and does not affect whatsoever the second generation.
Syphilis
Syphilis is one of the oldest diseases in human history. Its ravages and destruction of health and life thruout many centuries up to our days have been such that it has been called a “black plague,” in distinction from the great “white plague,” tuberculosis. It is hard to say which one of the scourges of humanity is superior in its destruction and wrecking of humanity. While tuberculosis apparently carries away more lives in their prime and selects victims principally among the young at the very height of individual happiness and social usefulness, Syphilis surpasses its terrible rival in its universal character of distribution, in the easier mode of infection, and more lasting presence of the poison in the human body. No country or climate is free from the scourge of Syphilis. No age, no station of life gives protection from its infection. Syphilis claims its millions of victims in all parts of the universe. It has populated cemeteries with untold numbers of bodies of still-born babies and infants who died in the early months of life; it has filled the insane asylums of the world with thousands of hopelessly insane men and women; it has crowded the institutions for the incurable and defective with paralytic adults and children crippled mentally and physically from birth.
The individual suffers as much from the ravages of Syphilis as society. Lucky is the man who can say that he is perfectly cured from Syphilis after two or three years of the most thorough treatment. Lucky is the man if he can be sure that later in life, after he may have forgotten all about his primary infection, the dormant germs of Syphilis lurking in the deep recesses of his body will not attack his most vital organs, as arteries, heart, or brain, and will not strike him down to permanent invalidism or slow but hopeless agony of an incurable disease.
Great as the latest medical discoveries in the recognition and treatment are, the course of the disease is so insidious and treacherous, and the treatment requires such persistence and patience and such expenditure of time and money, that probably no more than half of the syphilitic patients carry out to the end the treatment and period of medical observation, and thousands and thousands of them are sure to be stricken down later in life with the above mentioned terrible after-complications of Syphilis, and are doomed to premature invalidism, paralytic diseases, and insanity.
DIAGNOSIS (RECOGNITION) OF SYPHILIS.
In every disease an early and correct diagnosis is an essential condition for a successful treatment. This is particularly true in Syphilis. The early recognition of Syphilis can prevent a development of most dangerous complications, can forestall the destruction of most vital nervous centers and organs.
The recognition of Syphilis is beset with peculiar difficulties, due to the fact that Syphilis has a remarkable tendency to imitate in appearance all possible diseases. This simulation is rendered particularly effective because Syphilis has universal and all-pervading distribution in the human body, and not a single part, organ, or tissue is free from the invasion of syphilitic poison. Until lately the diagnosis of Syphilis was based on the rather uncertain basis of clinical experience, but the latest medical discoveries have put it upon a more definite foundation, and rendered it immeasurably more certain.
The first step in this direction was the discovery by a French scientist, Shaudin, of a germ producing Syphilis, a germ that he has called _Spirocheta pallida_. Spirocheta under the microscope looks very much like a corkscrew, and can be easily demonstrated in all fresh Syphilis sores. A finding of Spirocheta at once and absolutely establishes a diagnosis of Syphilis. Another valuable method by which a doubtful or latent case of Syphilis can be recognized is a _blood test_, known by the name of its discoverer as _Wasserman Test_. This is a very complicated test, requiring a highly-developed technic, and it can be properly done only in specially equipped laboratories.
The Wasserman test is not as absolutely sure and positive as finding of Spirocheta, yet it is very useful, and indeed indispensable in many cases of latent Syphilis, i. e., Syphilis that does not show any active symptoms like sores, breaking out, etc.
There is one more way to test the blood for Syphilis—_luetin test_, discovered by a Japanese scientist, Noguchi. Luetin test is made by injection in the skin of a certain substance, and also is very useful in old and latent cases of Syphilis. Recognition of Syphilis by the appearance and character of the sores and skin eruptions is in many cases very difficult, and can be done in doubtful cases only by a physician specially trained in this class of diseases.
CLINICAL COURSE OF SYPHILIS.
The clinical course of Syphilis is usually divided, for the sake of convenience of presentation, into three periods.
PRIMARY PERIOD OF SYPHILIS.
The first manifestation of Syphilis in the human body is a primary syphilitic sore, so-called _hard chancre_. This chancre _appears usually two or three weeks after exposure_, and this is a very important point to remember. Most men think that every venereal disease shows up a day or two after intercourse, and if a week passes without any signs of infection, they congratulate themselves upon having escaped the penalty of the transgression. Therefore when, two or three weeks after the exposure, they notice a small pimple or nodule on the genital organs, they ascribe it to some accidental cause, and never think of the possibility of it being of a venereal nature. This error of judgment is rendered particularly easy by the fact that the initial syphilitic sore has such a harmless, insignificant appearance, and is commonly so free from any pain, discomfort, or acute distress, that the patient, as a rule, ignores it, believing it will pass away by itself, or applies some ordinary salve. Only after they see that this “pimple” does not disappear, and gets harder and bigger in size, only then they become alarmed and consult a physician. This is the reason that so many patients present themselves to the physician when the syphilitic poison has already spread all over the body and has broken out in a general eruption.
A deceiving appearance and mild clinical course of primary syphilitic chancre that gives to a patient a false feeling of security cannot be too strongly emphasized and warned against. The following injunction seems to be well indicated to all men taking chances with venereal infection: _Beware of the little, painless, insignificant pimple on the genital organs, that comes up two or three weeks after exposure and shows a tendency to become firm and hard on touch._
Primary syphilitic chancre may look like a plain pimple or swelling without any sore on it, or it may present a greasy-looking ulcer with a very slight discharge, but all syphilitic chancres have _one characteristic feature_ always present; this is a hard, almost wooden feel and _firm consistence on touch_.
SYPHILITIC BUBOES.
Shortly after the appearance of primary chancre the patient notices a swelling of the glands in the groin on one or both sides, which feel like hard nuts, _syphilitic buboes_. These buboes never turn into an abscess, and remain hard for many, many months, until, under treatment, they slowly go down.
MIXED CHANCRE.
The fact that a man two or three days after an exposure begins to show a sore of Chancroidal type does not mean that he is already safe from developing a syphilitic chancre besides. In fact, it is a quite common occurrence that after development of typical Chancroid, in a week or two this sore begins to change in appearance and turns gradually into a syphilitic chancre. In other words, this man has contracted a double infection of both chancres, only their appearance takes place at different times, according to the difference in the length of time of their periods of incubation. The treatment of these mixed cases is naturally of more complicated character.
SECONDARY PERIOD OF SYPHILIS.
The secondary period of Syphilis begins with the first evidence that the syphilitic poison has spread all over the body, and that Syphilis from a local sore has become constitutional-blood disease. It takes usually about _six weeks_ from the time of appearance of the primary chancre until the development of the constitutional symptoms. The very first symptom of the constitutional syphilis is a general rash, which has such a peculiar appearance that no competent physician has any difficulty in recognizing its nature. Together with the skin eruption, so-called “_mucous plaques_” can be seen in the throat, on the tongue, lips, etc. Very often syphilitics of the secondary period suffer from attacks of fever and get rapidly run down and wasted. In fact, an experienced physician can recognize a syphilitic by a peculiar paleness and general appearance suggesting slow waste of the body by some chronic poison.
The most common complaints in the secondary period of Syphilis are: Severe headaches and boring pains in the bones, particularly at night; different skin eruptions and patches of mucous plaques around the mouth or genital organs. These mucous plaques contain millions of active spirochetae, and for this reason the _secondary period of Syphilis is the most dangerous period for transmission of the infection_. The secondary period may last from a few months to one to two years, depending on the gravity of the case and the character of treatment.
TERTIARY PERIOD OF SYPHILIS.
The tertiary period of Syphilis is the longest in duration and the most dangerous stage of the disease. It gradually succeeds the secondary active period of Syphilis and lasts, if not treated thoroughly, for many years, and sometimes thru the entire life.
The main characteristic of this period is that its lesions (sores) are fewer, but they are very deep and penetrate to the most vital and important organs, such as blood vessels, heart, spinal cord, and brain. This is the time when syphilitic germs, after a long period of apparent cure of the disease, suddenly renew their destructive activity and strike down their victim with some permanently crippling and incurable chronic disease. It has been mentioned before that Syphilis does not spare a single part or organ or tissue of the body. Anywhere, in the deepest recesses of the most vital and life-bearing centers of the body, a tumor of tertiary Syphilis can form, so-called _Gumma_, that has a natural tendency to break down, forming an ulcer and leading to a terrible destruction of tissues.
We shall not tire the reader by a detailed description of the possible results of this destruction of the body; it is sufficient to say that death is a welcome relief to the crippled, palsied, and insane victims of advanced Tertiary Syphilis. We shall mention only two diseases that are definitely proven to be after-results of Syphilis—diseases that are both incurable and that count as their victims countless thousands of men all over the world.
The first, a _progressive paralysis_, a chronic, progressively increasing insanity, that draws out for many years and invariably ends fatally, after a long agony of physical and mental decay and waste.
The second disease is _Locomotor Ataxia_, a chronic, slowly-spreading decay of the spinal cord, in which are located the most important nerves controlling the sensation and locomotion of the body. As the result of the slow death of these nerves, a man is gradually transformed into a helpless and hopeless paralytic, doomed to stay bedridden for life.
Any and all complications of Tertiary Syphilis can arise and strike down a man in a most insidious and unexpected manner. The most dangerous and deceiving feature of syphilitic lesions is that they develop painlessly and without acute distress or discomfort to the patient, who becomes aware of the disease only after a considerable amount of tissue is destroyed and irreparable damage has been done. No man who has a syphilitic chancre is safe from a possibility of development of complications of Tertiary Syphilis unless his blood, after repeated tests, has been pronounced pure and free from syphilitic poisons.
HEREDITARY SYPHILIS.
Nowhere else are the ravages of Syphilis more destructive and cruel; no other disease punishes the offspring for the sins of its parents so ruthlessly and wantonly; no other scourge inflicts its terrible retribution on the second generation at such a tender age as hereditary Syphilis. Hereditary Syphilis is undoubtedly the saddest and most gruesome chapter in the long black record of Syphilis.
The offspring _may inherit Syphilis from his father_ thru sperma (semen), _from his mother_ thru ovum and blood circulation, or it may get infection _from both parents_ at once. Most of the cases are due to infection from the father. Fortunately, experience has shown that the older the case of Syphilis is, and the better it has been treated, the more chance the offspring has to escape a syphilitic heredity, and the milder will the infection be if it be inherited.
If a man in the active stage of Syphilis marries a healthy woman, whether she herself be infected or not, she will not bear living children for a certain period of time. The first two or three years she will miscarry in the early months of pregnancy, a truly merciful provision on the part of nature, as death is certainly preferable to the drawn-out agony of the little creature, mutilated and crippled from birth. A little later the wife of a syphilitic is able to carry children to a full term, but they are born with the indelible stamp of loathsome heredity on their dwarfed bodies. The appearance of such children is as pitiful as it is repulsive. Wizened, old-looking faces, stunted bodies, numerous sores and skin eruptions, bone deformities, soft joints, due to decaying of bone ends and skulls distended with water; these and many other defects are the legacy these innocent victims come into the world with. Naturally, the vitality of such children is so low that many of them die in early infancy. Yet some of them can be saved by an early and thorough treatment. The farther it goes the more healthy-looking children are born, the fewer evidences of syphilitic heredity they present, and the later in life these evidences develop. Gradually, as the father or both parents receive proper treatment, their offspring born are more and more healthy and free from taint. _There is no question whatsoever that syphilitic parents, one or both, can have, after they have cured themselves, perfectly healthy children, physically and mentally free from any blood taint or possibility of later relapses._
TREATMENT OF SYPHILIS.