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.
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.