Read Ebook: Porneiopathology A Popular Treatise on Venereal and Other Diseases of the Male and Female Genital System; With Remarks on Impotence Onanism Sterility Piles and Gravel and Prescriptions for Their Treatment by Culverwell Robert James

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Page. GENERAL REMARKS 7 Anatomical and Physiological Review of the Male Organs of Generation, with eight engravings 7 Of the Testicles, their Structure and Functions, with seven engravings 14 On Gonorrhoea, or Morbid Secretion and Irritability of the Urethra, with five engravings 20 The Surgical Treatment of Gonorrhoea, with prescriptions 26 Medical Treatment of Gonorrhoea and its Consequences, with engravings, prescriptions, and specific remedies 29 On Gleet 41 Morbid Irritability of the Urethra 44 Stricture of the Urethra, with fifteen anatomical engravings and diagrams, illustrative of the nature of the disease 45 Treatment of Stricture, with thirty engravings, explanatory of the mode of treatment, prescriptions, &c. 58 Diseases of the Testicles, with three engravings 68 Hydrocele 69 Radical Cure of Hydrocele 71 Hydrocele Cured by Acupuncturation 71 Diseases of the Bladder 73 Irritability of the Bladder 74 Paralysis of the Bladder 75 Inflammation of the Bladder, with prescriptions 75 Origin of the Venereal Disease 79 On the Character of the Syphilitic Poison 84 Of Syphilis, with fifteen engravings 86 Of Buboes, with two engravings 93 Of Lues Venerea, or Secondary Symptoms 96 Of the Symptoms of the First Stage of Lues, with eight engravings 98 On the Treatment of Syphilis 104 Treatment of Chancre, with prescriptions 106 Bubo, with engravings and prescriptions 112 Secondary Symptoms 117 Syphilitic Eruption, with an engraving 117 Sore Throat, with prescription 121 Venereal Affections of the Bones, Joints 122 Secondary Symptoms 123 Treatment of Ditto, with prescriptions 125 Syphilitic Lepra 127 Nodes and Pains in the Bones 128 Syphilitic Sore Throat, with prescriptions 130 Advice to Invalids 133 The Female Organs of Generation--their Structure, Purposes, and Diseases, with thirteen engravings 136 On the use of the Speculum, with an engraving 150 Gonorrhoea in the Female 151 Syphilis in Females, with five engravings 152 Leucorrhoea, or the Whites 154 Treatment of Ditto, with numerous prescriptions 155 Effects of Incontinence, Celibacy, and Marriage 162 On the Hereditary Transmission of Disease 169 On Impuissance, or Impotence 173 Impotence and Sterility of the Male--four engravings 174 Impotence and Sterility of the Female--five engravings 180 Treatment of Impotence 184 Sexual Debility 188 On Piles, internal and external, with prescriptions and four engravings 191 Prolapsus of the Rectum, with an engraving 196 Stricture of the Rectum, with an engraving 197 Diseases of the Urine, with three engravings 200 On Incontinence of the Urine 204 The Gravel 212 Cause of Gravel 213 Treatment of Gravel 213

POPULAR TREATISE

VENEREAL DISEASES.

GENERAL REMARKS.

The cut below shows a section of the cavernous body, showing the blood vessels that go to it and cause a distension or erection of the penis:

In the cut above we see the septum or division of the cavernous bodies, in which are seen the vessels by which, when the erection of the penis subsides, the blood passes into the dorsal vein of the penis.

The urethra is constantly moistened with a mucous secretion,--from the membrane itself, the glands, and the folds which yield to the pressure of the urine as it flows, or from other altered conditions of the urethra pour out their contents. The inner surface of the urethra is very vascular and sensitive, as is shown by the slightest laceration by the bougie or by chordee, when considerable bleeding often takes place. Its sensitiveness is well known in the first passing of the bougie, or in inflammation, when the pain of the former and the act of urinating in the latter, often causes fainting.

The bladder is the reservoir of the urine, which is formed in the kidneys, comes into the ureters, passages leading from the kidneys to the bladder, and thence flows, drop by drop, into the bladder. The bladder is shaped somewhat like a pear, but this shape is varied by its contents, and the relative condition of its adjacent parts. Thus, when the bladder is full, its upper part may be felt rising above the pubis, that portion of the lower part of the belly that is covered with hair. In very fat persons the bladder is flattened by the weight of the intestines, and obliged to find room where it can, as in pregnant women. Anatomists, when describing the bladder, speak of its body, base, or upper part, sides and neck, where the urethra or water passage begins, and which is surrounded by the prostate gland. These parts are seen in the first engraving on the opposite page.

The bladder is composed of several coats. There is a peculiar membrane investing the important structures in the abdomen called the peritonoeum. The base and back part of the bladder is covered by a portion of this peritonoeum, which in a measure supports the bladder in its position, and also exercises certain properties which may hereafter be alluded to.

The following cut represents the muscles of the perinoeum exposed, the superficial fascia having been removed.

A brief description of the structures displayed in the two preceding and the following drawing will render this part of our subject perfect.

The office of a Sphincter Muscle, of which we have several, as that of the bladder and anus, is to keep closed the aperture they surround. The sphincter ani closes the rectum, and pulls down the bulb of the urethra, by which it assists in ejecting the urine and semen.

The Levator Muscles lift up the part they are connected with. The levator ani muscles form the funnel appearance of the rectum, and help to draw it up after the faeces or stools are evacuated. They also assist in sustaining the contents of the pelvis, and help to eject the semen and urine, and contents of the rectum, and, perhaps, by pressing upon the veins, contribute to the erection of the penis.

The Gluteal Muscles help the rotatory motion of the thigh, and give support generally to the buttocks.

The Sacro-Sciatic Ligaments assist in the firm union of the bones of the pelvis.

The Erector Muscles of the penis propel the urine and semen forward; and, by grasping the bulb of the urethra, push the blood toward the corpus cavernosum and the glans, and thus distend them.

The Accelerator Urinae Muscles, as their name implies, help to eject the urine and semen.

The Triangular Ligament of the urethra assists the preceding purposes.

The testicles, thus suspended, have two coats, one adhering closely, and the other loosely surrounding the former--between the two, a lubricating fluid is secreted, whereby the various movements of the body are permitted without injury; it is between these coats that water is secreted occasionally, constituting the disease known as hydrocele. The closely fitting coat is termed from its whiteness and density Tunica Albuginea--the other Tunica Vaginalis. These coverings are formed of that extensive membrane in the abdomen called the Peritonoeum. The Tunica Albuginea which surrounds the testicle previous to its descent, accompanies it into the scrotum, propelling, as it were, the Tunica Vaginalis before it. On the descent of the testicles into the scrotum, the opening through which they passed becomes impermeably closed.

The annexed diagram will explain the coats and facilitate the understanding of subsequent descriptions.

The preceding completes the anatomical description of the Testicle. The semen is supposed to be secreted by the arteries that ramify among the seminal tubes; the last drawing exhibits the testicle as from the hand of the dissector. In life and in health the epididymis is attached to the testicle--the vas deferens passes up the chord, enters the abdomen, and, passing down into the pelvis, terminates in the vesiculae seminales as already, but to be again, alluded to. The two subjoined drawings illustrate the testicles in their natural situation.

In the larger figure the testicle is displayed as enveloped by its coverings, and in the lesser as stripped of them. The references serve for both.

We now come to speak of the Vesiculae Seminales. It was just observed, that the Vasa Deferentia terminated in these structures. They are attached to the lowest and back part of the bladder, behind the Prostate Gland. The following drawing is the prelude to the description--It represents the Prostate Gland, the Vesiculae Seminales and the Bladder.

The Vesiculae Seminales appear like two cellular bags. They have two coats, the one called nervous, and the inner the cellular, a membrane divided into folds or ridges. The use of the vesiculae is supposed to be, to act as reservoirs for the semen; but there are different opinions upon the subject, some contending that they furnish a fluid, not spermatic, but merely as an addenda to the seminal secretion; whereas others, who have examined the vesiculae of persons who have suddenly died, have discovered all the essential qualities of the male seed therein; and, in fact, physiologists, who direct researches in these matters, advise such examinations as the surest means of obtaining, in a state of purity, the seminal fluid.

President Wagner thus describes the germe of future animal life: "The seminal granules are colorless bodies with dark outlines, round and somewhat flattened in shape, and measuring from 1-300 to 1-500th of a line in diameter." "The animalcules exist in the semen of all animals capable of procreation. They are diversified in form in all animals according to their species, but in man they are extremely small, scarcely surpassing the 1-50th, or almost the 1-40th of a line in breadth. This transparent and flattened body seldom exceeds from the 1-6th to the 1-800th of a line in length."

The annexed drawing exhibits the granules and animalcules of a human male being magnified from 900 to 1,000 times:--

The semen is never discharged pure; it is always diluted with the secretion from the prostate and other glands, and also the mucus of the urethra. A chymical analysis is thus given of 100 parts:

The semen may certainly be vitiated and diseased: the odor and color assume all the gradations of other secretions when in a morbid condition.

Semen not discharged is supposed to be absorbed, thereby adding to the strength and nutriment of the economy; but as it is furnished for a specific purpose, and its secretion depends much upon the play of our animal passions, and as they are rarely permanently idle, there is not only the inducement that the fluid be furnished, but also emitted, and hence we have nocturnal emissions. These, to a degree, are salutary; but they may happen so frequently that the function becomes disordered and perverted, and in some individuals the semen escapes during sleep, or on the slightest local excitement of riding, walking, or on the action of the bladder or rectum.

The prostate gland, as has been stated, contributes much to the dilution of the semen; it may empty itself independently of it. The gland is composed of numerous cells, from which proceed some twenty or thirty pipes or passages that open in the urethra by the sides of the verumontanum, as shown in the drawing.

About this time is perceived a slight heat on passing water, or at the conclusion of the act; and shortly after, or may be before, a yellowish discharge is observed oozing from the mouth of the glans or nut of the penis; the symptoms then rapidly advance, unless timely and judicious means be adopted to palliate them or effect a cure; the scalding becomes intense, and the pain and smarting continue some time after each operation of passing water: the discharge becomes profuse and clots on the linen, and continues to ooze out with little intermission: the orifice of the urethra looks red and inflamed, and the glans itself swells and is occasionally extremely tender: the foreskin or prepuce sometimes, but fortunately not always, becomes swollen, and tightened over the nut of the penis, from which it can not be drawn back, constituting that form of the disease known by the name of phymosis. See drawing annexed.

When that is the case, other annoyances ensue; the purulent matter collects around the glans; excoriations, ulcerations, and sometimes warts, are the consequence; the whole symptoms become thereby much aggravated. It also happens that the prepuce from inflammation assumes a dropsical appearance, that is to say, the edges or point swell, and appear like a bladder filled with water; thus, the size which the penis then arrives at is enormous, and to the patient very alarming; it usually, however, subsides in a day or two, if rest and proper measures be employed.

The annexed diagram exhibits the foreskin in a state of paraphymosis.

The first indication of the approach of the last-named affection is a slight sense of fulness in the testicle, generally the left first, although occasionally in the right, sometimes one after the other, but rarely both together: a smart twinge is now and then felt in the back upon making any particular movement: the testicle becomes sensibly larger and more painful, the chord swells also and feels like a hardened cord in the groin: the patient is soon incapacitated from walking, or walks very lame; if the inflammation be not subdued by some means, and if the patient be of a "burning temperament," that is, of a very inflammatory constitution, fever is soon set up, and the patient is laid upon a "sick bed." There is no form of the complaint so dangerous to neglect as swelled testicles; they have sometimes been known to burst or become permanently callous and hardened, and ever after wholly unfit for procreative purposes: in other instances, they have entirely disappeared by absorption: in fact, all diseases of the testicles interfere with the generative power. At the onset of inflammation there may be a brief increase of sexual appetite, but when the structure of the testicle becomes altered or impaired, that appetite is subdued or wholly lost; there is such a wonderful sympathy betwixt all parts of the generative economy of man, that if one portion only be injured, the ordinary end of sexual union is frustrated.

The gonorrhoeal poison is capable of producing a similar discharge from other parts to which it may be applied besides the urethra. It has been conveyed by means of the finger or towel to the eyes and nose; and a purulent secretion , has oozed plentifully therefrom. Gonorrhoea is an infectious disorder, and consequently is communicable by whatever means the virus be applied. It certainly is possible, and , it certainly is not improbable that it may be taken up from using a water-closet that has been visited by an infectious person just before. It may also be contracted by using a foul bougie.

If the gonorrhoeal discharge be suffered to remain on particular parts of the person, such as around the glans of the penis, or on the outside of the foreskin, excoriations, chaps, and warts, spring up speedily and plentifully, and protrude before the prepuce, or sometimes become adherent to it, as here drawn: it therefore only shows how necessary cleanliness is in these disagreeable complaints, to escape the vexations alluded to. A species of insect also is apt to appear about the hairy part of the genital organs, and indeed extend all over the body, particularly in those parts where hair grows, such as under the armpits, chest, head, &c., if cleanliness be not observed. They are called crabs. The itching they give rise to is very harassing, and the patient, unable to withstand scratching, rubs the parts unto sores, which, in healing, exude little crusts that break off and bleed.

I come now to add to the list of calamitous consequences, stricture, which, in my opinion, prevails to an enormous extent; however, its consideration will be reserved, as well as the affections of the bladder, and prostate gland, for their proper places. I will simply repeat my impression that a stricture, or narrowing of the urethra, or some organic changes, invariably ensue when the gonorrhoea has been mismanaged, or its cure unfortunately protracted.

It is the opinion of many medical men, and it can, no doubt, be borne out by many patients, that a gonorrhoea if unattended by any untoward circumstance, will wear itself out, and that the duration of such a proceeding is from one to two months; there is no disputing but such has been, and is now and then the case, but such rarely stand even so fair a chance of recovery as to be left entirely alone: even if medicine be not taken, rest, abstemiousness, and such like means, are seldom followed up; either the patient lives gloriously free, or else goes to the opposite extreme.

The cases of gleet which seek medical relief are more numerous, as most professional men must be aware, than those of gonorrhoea, for the reasons so frequently alluded to; the fair inference would be, that a gonorrhoea seldom escapes the terminus of a gleet.

The distinguishing feature of gleet from gonorrhoea is that it is not considered infectious: it consists of a discharge ever varying in color and consistence; it is the most troublesome of all urethric derangements, and doubtlessly helps more to disorganize the delicate mucous membrane lining the urinary passage than even the severest clap. Its action is constant though slow; and subject as we are to alternations of health, of which even the urinary apparatus partakes, it is not to be wondered at that a part of our system which is so frequently being employed, should become disturbed at last, and that stricture and all its horrors should form a finale; but as gleet and stricture form in themselves such important diseases, I shall devote a chapter to the consideration of each separately.

To cure this disease I find that in many cases, if the parties apply at the very onset of the disease, before the discharge and scalding have set in with anything like severity, and they themselves be not of a very inflammatory temperament, that a sharp stimulating injection will at once subdue the sensitiveness of the urethra and alter the action, and, at the cost of very little, and that only temporary suffering, effect a speedy cure: the mode, except it be by stimulating the relaxed vessels, or owing to the specific action of the injection, is, like all other medical operations, a mystery. A favorite prescription is the nitrate of silver, say one scruple of the nitrate to the ounce of water, but the disease must be thus treated at the very first symptom: the patient must be otherwise in comparatively good health, and his occupation must not expose him to much bodily fatigue. He must not be given to intemperance, nor should those instances be selected where the sufferer is of a very inflammatory constitution. Experience begets confidence, and confidence begets experience. In cautious hands I am satisfied of its usefulness; but there are cases that turn out failures. I have used the injection when the disease itself was a week old, and with like success; but I am ready to confess I have known cases, the cure of which were retarded by its employment. The inflammation has been temporarily aggravated, but they were cases where the treatment was not appropriate; the disease was far advanced, there was much heat and swelling, and the patient's health was in most instances considerably affected; but yet beyond the few hours' of suffering merely, no extraordinary symptoms were produced. The cure was very shortly after effected by means which I shall presently allude to.

In all cases of suspicious connexion I recommend copious ablution as soon as possible. The syringes I would advise to be used should have their points conically shelved off pear fashion; they fill up the urethra like a wedge, and prevent the immediate escape of the injection: all injections should be retained a few seconds, and then be allowed to flow out. It is seldom worth while to repeat the operation more than twice on an occasion; but that occasion may be resorted to two or three times a day.

When the nitrate of silver is used, the syringe had better be made of glass. The nitrate of silver discolors the skin, linen, &c.; therefore gloves should be worn, and care taken that the fluid be not spilt over the person or dress, but should the skin be stained, it can be removed by a strong solution of hydriodate of potash.

The plan of injection, I must remind the reader, is only applicable in early and old cases. The recent cases, as I have before stated, are less frequently before the medical man than what we may call a "ripe" gonorrhoea. The old cases present also some difference as to the cause of their continuance, and require also some difference in their treatment, and they will be introduced under the chapter headed "Gleet."

The symptoms of a clap, fully developed, are severe scalding, voluminous discharge, painful erections, local inflammation, probably phymosis or paraphymosis, glandular swellings, and possibly swelled testicle.

But all cases of gonorrhoea are not ushered in with such severity; nor do many, if common cleanliness and quiet only be maintained, experience even the various accompaniments just described, and still fewer would if the following precautions and measures were used.

Our plan, however, is as follows: in the first place, I take into consideration the appearance of the patient; if he be strong, robust, sanguine, or of full habit, and youthful--if it be his first attack, and if the symptoms be ushered in with any degree of severity, I invariably and rigidly pursue the antiphlogistic course of treatment; if the case be in a person of phlegmatic temperament, of mature age, and the disease be but a repetition of the past, and there be no evidence of physical excitement, I fearlessly adopt the specific. Where, in the third place, I encounter a patient with no very prominent peculiarity, nor with symptoms demanding extraordinarily active measures, experience has taught me the propriety of cautiously combining the two methods--a mild aperient had best always a precede a tonic or a stimulant, in cases where there is a doubt of inflammation lurking in the system; and, recollecting the tendency our complicated organization has, when assailed by a distemper, to become irritable, it is always as important to know when to withhold a remedy as when to prescribe one.

The three following imaginary cases will serve as no inapt illustration of the principles laid down:--

However, to particularize the treatment for each symptom; to commence, I will request the reader to remember that on the first appearance of gonorrhoea, attended with an unusual inflammatory aspect, I practise, where permissible, venesection; if the case demand it not, at least there should be administered an aperient; let, therefore, a dose of opening medicine be taken immediately . This is the first step toward reducing inflammatory action--the next should be directed toward allaying the local symptoms, by diminishing the nervous irritability of the urethric passage.

With this view, no plan surpasses that of bathing the penis in warm water, or immersing the entire body in a warm bath. The former should be repeated several times in the day; the latter daily, or certainly on alternate days, so long as the severity lasts.

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