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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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.

To lessen the acrimony of the urine, which keeps up the irritability, and somewhat to lower the system, all strong drinks, such as ale, beer, wine, and spirits, should be avoided, and milk, tea, barley-water, toast and water, linseed tea, gum arabic in solution, and other such mucilaginous diluting liquors taken instead. The diet should be lowered: in fact, a spare regimen should be adopted, not wholly abstaining from animal food, but partaking of it only once in the day, and carefully excluding all salted meats, rich dishes, soups, gravies, &c. The usual employment should be suspended, and rest should be taken as much as possible in a recumbent posture.

Of course the preceding remarks apply only to cases of severity; I mean such cases as first attacks ordinarily prove; and which remarks, if attended to, will greatly mitigate the violence of the disease.

To assist the foregoing treatment, the aperient medicine, which should be repeated, at least, on alternate days, until the inflammation is ameliorated, should be followed by some saline or demulcent medicine to allay the general disturbance. Several formulae are suggested for that purpose, suitable to various temperaments and conditions--

But we need not rest satisfied with merely "showing" the disease through its stages; we can expedite it, and many of its steps we can skip over, and here it is we may call to our aid the specific method of treatment alluded to. This specific method consists of the suspension of a vitiated secretion, and a restoration of a healthy one. Now how this is effected we know not; we only know that it can be done--and experience has taught us that it may be done safer at one time than another. During the existence of a fevered state of the circulation, it would be highly impolitic suddenly to check a discharge from any surface, much less one situated like the mucous membrane of the urethra, in the immediate connexion, as it is, of important nerves and glandular structures--a metastasis of the inflammation will almost invariably ensue; and hence we account for swollen testicles, buboes, painful affections of the bladder, &c. Whereas, on the subsidence of inflammation, the revulsion is borne; and to our satisfaction, the disease disappears. A constitution in a state of excitement is like a fretted child--it will have its "will" out, and the rod is not always the safest corrective.

On the subsidence, therefore, of the scalding, and a lessening of the general fever, the specific plan of treatment may be commenced. Upon the same principle that the surgical treatment is selected according to the symptoms, so also are the just-named preliminaries in many cases dispensable, and hence, as hereafter detailed, it will be found that the antiphlogistic and specific do not go always hand in hand. However, to explain the latter:--

For instance, cubebs may be taken alone, in water, in doses of a tablespoonful twice or thrice daily. If cubebs produce no good effect in four or five days, it had better be discontinued, and other means sought after.

These proceedings usually carry the disease to a close, and, if no adventitious circumstances occur, successfully and speedily. It is well to deserve success, but it can not be always commanded.

The business engagements of young men render it almost impossible for them to devote that care and attention so importantly requisite; and few, consequently, will be found who will be fortunate enough to escape the usual concomitants of a gonorrhoea.

Where, therefore, the scalding or passing the urine is very severe, the pain may be mitigated by carefully injecting, previously to making water, either of the formulae No. 11 or No. 12 into the urethra.

The inflammation extends in general not more than two inches down that passage, so that much force is not required to inject the intended fluid, nor should an unnecessary quantity be used.

When the inflammation reaches the bladder--which is indicated by pain in that viscus and the perinoeum, with a constant desire to pass water--the taking of a warm bath at a temperature of 100?, and remaining therein for a quarter of an hour, will afford essential relief.

When a chordee is attendant on a gonorrhoea, and the patient can not sleep, the draught may be taken on going to bed, or the powder in some gruel. The embrocation rubbed on the parts affected, however, will instantly remove both the pain and the spasmodic contraction, and not unfrequently prevent their recurrence. Care must be taken that the embrocation be only used for its specific purpose, and not swallowed by mistake, as it is poisonous.

In the event of the patient being obliged to follow his ordinary occupation, or to go about, the use of a suspensory bandage will be found of great benefit; indeed it is indispensable, and the neglect of it has often brought on swelled testicle, or most excruciating chordee.

The consideration of the symptoms here following is not in the order in which they always occur; for swelled testicle may ensue without phymosis or paraphymosis preceding, or even being present; and the converse holds equally good with regard to every other.

The successful treatment of phymosis depends very much upon local management. Bathing the part frequently in warm water, the daily use of the warm bath, and the frequent injection, by means of a syringe, of warm milk and water, are generally all that is required to reduce phymosis; but where it is attended with much inflammation, where the glans is excoriated, probably by the discharge from the urethra accumulating between it and the prepuce, and thereby inducing irritation, bleeding is even sometimes necessary, the strictest antiphlogistic regimen should be preserved, and the treatment advised in the early stages of gonorrhoea scrupulously followed.

Sometimes the prepuce becomes so swollen as to assume an oedematous or dropsical appearance; in which case it may be scarified with a lancet, or several leeches applied. With the exception of concealing the state of the glans, phymosis is less dangerous than paraphymosis, and is most usually produced by the patient worrying the part, by frequently uncovering the glans to observe its condition. Where a discharge is perceived oozing from beneath the prepuce, which is not urethral, and the glans does not feel sore or tender, the injection syringed up five or six times a day, will prove very efficacious in healing the ulceration.

Where there is an unnatural elongation of the prepuce, it will be constantly subject to phymosis, not only from gonorrhoeal inflammation, but from the accumulation of the natural secretions of the part. In that case, cleanliness is the only remedy the patient can employ of himself. Occasionally it is necessary to have recourse to the surgeon's knife.

Paraphymosis is the opposite to phymosis, and usually arises in this way: the orifice of the prepuce, being contracted by the inflammation, is drawn back for the purpose of washing or examination, and is allowed to remain, or, as frequently happens, it can not be redrawn. When this continues some time, considerable inflammation, both of the glans and prepuce, arises. The contracted orifice pressing more tightly, it will often happen that a sloughing of both it and the glans will take place; but this occurs only in consequence of neglect, or in constitutions injured by intemperance.

If seen and attended to early, this state may be removed very easily. The penis should be immersed in a basin of cold water, or sponged, so as to cool it as much as possible; or it may be well oiled. In either case there will not be much difficulty in pressing up the glans and drawing up the prepuce over it; but where adhesion has taken place, or ulceration exists, it will be harder to accomplish: the adhesions must be separated, or the stricture divided with the scalpel.

I need scarcely observe, that such an operation is out of the province of the non-professional person, who should lose no time in consulting his surgeon.

I omitted to mention, in the description of the symptoms of gonorrhoea, that occasionally, in very severe cases, a tumor forms in the perinoeum, which, if neglected, proceeds to suppuration, and establishes a fistulous communication with the urethra. On the instant of such a swelling appearing, leeches, fomentations, and poultices, should be applied with a view to disperse it; but the management of such a case had better be intrusted to the surgeon.

Excoriation of the membrane of the glans or prepuce requires for its treatment frequent ablution with warm water until the redness and discharge somewhat diminish, when Form 16 may be resorted to, and applied, if practicable, by a moistened layer of lint; but if accompanied by phymosis, the syringe must be used.

Warts, if not large, are easily removed, by brushing them with the muriated tincture of iron, or the application of a lotion of lunar caustic .

Where they are numerous and large, and resist the remedies just recommended, the nitric acid is an excellent escharotic; it gives little or no pain, and is rarely productive of inflammation. The glans, if not naturally denuded , should be kept so for a time; and the nitric acid, after a few moments, washed off with cold water. Notwithstanding, excision is sometimes necessary to their complete removal.

When the organs of generation are infested by pediculi, or crab-lice, the most efficacious and agreeable remedy is the sulphur-bath; one bath generally effecting an extinction of every one of them, even though they be all over the body.

Some recommend shaving the hair off the pubis, the locality in which the vermin are most usually engendered, and applying blue ointment or the black wash. Such a practice is seldom ineffectual, but the irritation attendant upon the reproduction of hair is absolutely intolerable. The hair need not be removed, as the above remedies will be all-sufficient without it. Rubbing the parts well with strong mercurial ointment, or the black wash , or even powdering them with calomel, will at once destroy the insects, and thereby remove the itching.

The timely and prompt loss of twelve or sixteen ounces of blood from the arm will often cut short the complaint, and render other remedies almost unnecessary; while the temporising delay, under the vain hope of the inflammation subsiding, will allow the disease to make rapid progress, and impose a necessity of several weeks' rest and absence from business, before a cure can be effected.

Immediately, then, on the occurrence of swelled testicle, I would recommend the patient to be bled--to take some aperient medicine, and, if the inflammation continues, to apply from twelve to eighteen leeches, and afterward suffer the wounds to bleed for twenty minutes in a warm bath; to retire to bed or to the sofa, and to maintain a horizontal posture. If he be strong, young, and robust, an emetic may be given previous to the aperient, which has been known to remove the swelling almost instantaneously.

Iodine also possesses a similar specific property in reducing swelled testicle, and may be taken during the inflammatory stage after bleeding and aperients, as may likewise the chlorate or hydriodate of potass .

With regard to local applications, the repeated employment of leeches, fomentations, and poultices, with the frequent use of the warm bath, and, above all, keeping the testicle constantly supported by means of a bag, truss, or suspensory bandage, will subdue the disease in a very short time, without impairing the functions of the important organ concerned.

Almost every case of inflamed testicle will terminate favorably by strictly pursuing the plan proposed; but when, from any untoward circumstance, the inflammation proceeds to suppuration, the case must be treated like one of common abscess, in which event professional aid should be sought for without delay.

Other diseases of the testicle will be treated upon under a specific head.

To return to the treatment of Gonorrhoea:--On the abatement of all or any of the enumerated symptoms, such as the diminution of the scalding upon making water, the subsidence of chordee, the escape from, or cure of, swelled testicle, phymosis and paraphymosis, warts, crabs, excoriations, &c., the discharge may still continue, though thicker in consistence, and deeper in color: and it is at this period, which I will call chronic gonorrhoea, when all inflammatory symptoms have left, that stimulants may be judiciously given; but it must be borne in mind that relapses often occur from imprudence: and this chronic form requires as much attention as the acute or early stage.

Thus, then, we may have gleet from gonorrhoea, gleet from ulceration, gleet from stricture, gleet from debility and discharges, popularly understood to be gleet, but in reality glandular secretions, which will be considered shortly and separately. Gleet is a tiresome and troublesome disorder. So difficult, occasionally, is its management, that oftentimes the more regularly a patient lives, and the more strictly he conforms to medical regimen, the more deceptive is his disorder. He will apparently be fast approaching to, as he conceives, a recovery, when, without "rhyme or reason," the complaint recurs, and hints that his past forbearance has been thrown away. It would be dispiriting, indeed, were every case of gleet to realize this description; but it is well known that many do, either from neglect or mismanagement. Now it must be evident that the treatment of gleet depends upon what may happen to be the occasion of it. Where the membrane of the urethra is entire, internal remedies may, and do avail. Copaiba will achieve wonders; the use also of a mild injection, perseveringly employed , will give tone and stringency to the weakened vessels, and so correct the quantity, at least, of the secretion. In very obstinate cases, stronger injections, as of the nitrate of silver, twenty grains to the ounce of water, are serviceable; and we are not without many useful internal medical combinations, which, properly administered, conquer this troublesome complaint. In ulceration and stricture, these two causes must be removed, else all efforts are unavailing. In general and local debility, the attention must be devoted to the constitution. Common sense and common reading must give to persons, possessing both, every necessary information. The community are beginning to appreciate the advantages of temperance, air, and exercise, too highly, to need instructions how much of the one or either of the other two are essential to the preservation or recovery of health.

In the midst of this contentment, the invalid finds that the process of urinating engages more time than formerly, the urine appears to flow in a smaller stream, and is accompanied by a sensation as though there were some pressure "behind it." The act of making water is not performed so cleanly as it used to be; the stream differs in its flow, seldom coming out full and free, but generally split into three or four fountain-like spirts, as the annexed drawing displays.

At other times it twists into a spiral form, and then suddenly splits into two or more streams, while at the same moment the urine drops over the person or clothes, unless great care be observed, as witness diagram.

In advanced cases, the urethra becoming so narrow the bladder has not power to expel the urine forward, and it then falls upon the shoes or trowsers, or between them, as observe illustration.

Persons afflicted with stricture, and urinating in the streets, may almost be detected from the singular attitude they are obliged to assume to prevent the urine from inconveniencing them, and also from the time occupied in discharging it. Some few minutes after making water, when dressed and proceeding on his way, the patient finds his shirt become moist by some drops of urine that continue to ooze from the penis; and it is only as these annoyances accumulate, he begins to think he is laboring under some other disease than the gleet. The next symptom he will experience will be a positive but temporary difficulty in passing his water--perhaps a total inability to do so; it will, however, subside in a few minutes. This will lead him to reflect, and he will even appease his fears by inclining to think it may be the consequence of his last night's excess: he resolves to be more careful for the future, and he gets better; his contemplated visit to his usual professional adviser, if he have one, is postponed, and a few more weeks go by without a return of the last symptom. The next attack, which it is very difficult to avert, and which is sure to accompany the succeeding debauch, or to follow a cold or fatigue, does not so speedily subside; the patient finds that he can not complete the act of making water without several interruptions, and each attended with a painful desire resembling that induced by too long a retention of that fluid. In that state he eagerly seeks medical assistance; the treatment generally adopted consisting of some sedative, immersion in a hot bath, or the passage of a bougie. Relief being thus easily obtained, professional advice is thus thrown up, and the symptoms are again soon forgotten. Before proceeding further with the more severe forms and consequences of stricture, which may now be fairly said to have commenced in earnest, a brief anatomical description of the urethra may enable the reader to understand how the constriction or narrowing of that canal takes place.

The difference of opinion entertained by some of our first anatomists, on the structure of the urethra, is deserving of notice; for only in proportion to the correctness of our knowledge of it, can we arrive at a just definition of its diseases.

One party assert it to be an elastic canal--whether membranous or muscular they do not say--endowed with similar properties of elasticity to India rubber, or to a common spring. That it is elastic, is beyond doubt; but the mere assertion is no explanation of its mode of action.

A spasmodic stricture they define to be "a contraction of a small portion of longitudinal muscular fibres, while the rest are relaxed; and as this may take place, either all round, or upon any side, it explains what is met with in practice--the marked impression of a stricture sometimes a circular depression upon the bougie, at others only on one side."

With respect to the change consequent upon permanent stricture, dissection enables us, in some degree, to arrive at the truth. Excrescences and tubercles have been found growing from the wall of the urethra; but in the majority of instances, the only perceptible change is a thickening of the canal here and there, of indefinite length; but whether it be occasioned by the exudation of coagulable lymph, or whether it be the adhesion of ulcerated surfaces, which I contend are more or less present in gleet, is not so easy to determine; at all events, it is undoubtedly the result of inflammation.

With regard to the action of spasm, all we know of it is theoretical; but experience every day furnishes instances of its occurrence.

The rationale is this: the patient, opposing the action of the muscles of the bladder, by contracting those of the urethra, they , from irritation, become spasmodically contracted.

The urine, by the powerful action of the muscles of the bladder, is forced against the contracted portion of the urethra; and by its irritation increases the mischief. Where neglected, or unless the spasms yield, extravasation will take place, mortification ensue, and death follow.

In passing a bougie in contracted and irritable urethra, it sometimes enters the opening marked B, and if violence be used in propelling the instrument, false passages are made.

Independently of the function of the urethra being to discharge the urine, it has also to convey the semen to the orifice of the glans; and here in this act is to be observed the wonderful adaptation of means to an end. During the excitement attendant upon venereal commerce, the seminal fluid accumulates, prior to emission, in the bulbous portion, and when the fitting moment arrives for its ejection, the membranous portion spasmodically contracts, thereby preventing the regurgitation of the semen into the bladder, while the muscles surrounding the bulbous portion contract with energetic force, and so complete the transmission of the generative fluid. Such are the functions of the urethra in health.

The positive changes which take place in stricture in the urethral passage are these: there ensues a thickening and condensation of the delicate membrane and the cellular tissue underneath, which may possibly unite it to the muscular coat. This thickening or condensation is the result of what we call effusion of coagulable lymph. It will be rather difficult to explain the process; but lymph is that fluid understood to be the nutritious portion of our sustenance or system, and which is here yielded up by the vessels which absorb it, and which vessels abound, with few exceptions, in every tissue of our body. However, it will suffice to say, that where inflammation takes place, there is an alteration of structure, and that alteration is generally an increase. In stricture, this increase or thickening takes place, as I observed before, in particular parts of the urethra, but where the inflammation is severe, no part is exempt, and whole lengths of the passage become occasionally involved. It is true, certain parts are more predisposed than others, as, for instance, the membranous, bulbous, and prostatic portions of the canal; but there are oftentimes cases to be met with where these parts are free, and the remainder blocked up. This effusion or thickening assumes various shapes, and selects various parts of the urethra. The subjoined diagram will convey a tolerably perfect idea of the malady in question; indeed it is a beautiful specimen of simple stricture.

To continue the description of the formidable consequences of neglected stricture.

The symptoms of permanent stricture are often as slow in their progress, and as insidious in their nature, as they are appalling in their results, and are seldom distinctly observed by the patient, until firmly established.

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