Venereal Diseases
Venereal diseases present a unique and most difficult problem of our days. To realize fully the enormous scope and difficulties of the control of venereal peril, several social factors bearing on this problem must be considered. Such are: The attitude of society to the sexual problem; double standard of morality; prevailing ignorance on the subject on the part of the public; self-medication and medical quacks; the sources of venereal infection, and the best methods of its control.
The Conspiracy of Silence.
Medically, venereal diseases belong to the oldest and best worked out class of diseases, tho their treatment only recently, due to the new discoveries, has been put on a definite and secure basis. Socially, their tremendous importance for the health, morals, and happiness of a community is just being disclosed to society, which heretofore, in its prudish and ostrich-like attitude, attempted to solve the problem of venereal peril by ignoring it and suppressing free discussion or preventive education along these lines. Naturally, the evil unchecked, tho driven underground by a prohibition of publicity, has spread to such a monstrous size that society could not any more feign not to see it and to continue the old policy of “conspiracy of silence.”
Double Standard of Morals.
Among factors bearing on the causes of sexual intemperance and venereal peril, possibly none stands out as clearly and prominently as the so-called double standard of morals. We all know that society has adopted and hypocritically approved a double code of sexual morality for men and women. What is considered to be natural and permissible for a man is an offense of morality and a crime punishable by social disgrace for a woman. No man is willing to marry a girl whom he knows or suspects to be of loose sexual morals, and no self-respecting man will tolerate that the fair name and honor of his sister be attacked or ruined even by a word, not to say in fact. And yet the same man, in full sincerity and in accord with his conscience gives to himself a free license of “sowing wild oats” before his marriage. In fact, many men believe that it is not only permissible, but even desirable for a young man to work off a surplus of his physical manhood before he settles down to family life. How a squandering of the best physical and nervous energy in dissipation, how a waste and perversion of the highest spiritual and moral instinct of love by a degrading purchase of the body of a prostitute, how a polluting of the young and pure blood with venereal poisons can make a man a better husband and father is beyond human reason and common sense to comprehend; but the superstitions and barbaric notions of the good old days are dying hard, and thousands of young men sacrifice their manhood to the deep-rooted traditions and to the slavery of established social habits.
How this double code of sexual morality has developed is probably to be explained by a combination of several factors. First, a historically developed subjection of the woman to man naturally has led to the domination of man’s ideas and laws, and to the interpretation of different facts bearing on the relationship between man and woman in favor of the man. To justify his own license of sexual intemperance and deny the same freedom to a woman, it was easy for a man to declare that the sexual necessity for a woman is not as imperative as for a man, and therefore a woman shall be chaste and pure until the marriage, while the man may suit himself in this regard. There is no scientific proof whatsoever that a woman differs in any way from a man in regard to the sexual instinct. It is true that woman, as an average, is purer, more temperate, less attracted by mere animal, brutal passion, and often seeks or tolerates a physical gratification only as the means to get with it a man’s love and affection. On the other hand, a man is more brutal and violent in seeking and satisfying his physical passion, less able to control his sexual impulse, less affectionate and less sentimental in his expression of love. But this comparative moderation, modesty, and better self-control can be more easily explained by woman’s training thru many generations in clean and moral habits of thought and living, by the fewer chances of exposure to evil influences, by less stimulation and intoxication thru liquors and tobacco, and last, but not least, thru fear of public disgrace. The man, being master of the situation, has never tried to develop self-control and will power in subduing his physical passion, and has cloaked his sexual intemperance and indulgence with a fancied natural necessity. The double moral standard as it is practiced to-day has brought untold misery and has ruined lives of millions of young women who were so unfortunate as to make a first misstep and yielded to temptation. While the male seducer goes on unmolested and unnoticed on his gay round of life, the girl, his helpless victim, has to face all the fury of public disgrace and contempt. Many of them commit suicide, others try to hide their disgrace by a criminal operation and die or cripple their health for life. Many more, in despair and revolt against the injustice and hypocrisy of public opinion, enter the gates that swing only one way to slow decay and untimely death, the gates of prostitution.
There is no more miserable existence, no more hopeless, no more body and soul-wrecking life than that of a white slave. It is no accident that practically all of the prostitutes are drinking and smoking, and that the majority of them are also drug fiends. In fact, that should rather be credited in their favor, as it shows that with clear judgment and normal senses they cannot endure this degradation and life-long slavery, and, since they do not see any possibility of breaking their chains and redeeming their lives, they drug themselves to forget their misery. Yet even continual drugging cannot dull the agony of their hopeless existence, and many of them welcome death at their own hands, usually thru poison. There is no other occupation or human walk of life where the suicide rate is as high as among the slaves of prostitution, neither is there any class of population where physical decay and premature death is as common as among the women of the underworld. Let a man or youth who enters a house of prostitution know that by doing so he is not only purchasing a lottery ticket for the prize of a venereal disease, which he seldom misses, but that also with each visit to a fallen woman he drags her down one step lower on the down-grade path of a social abyss. And if he can do this with full knowledge of the social consequences of his act with a clear mind and cool judgment, let him know that he is a man in name only, and that morally he is much more to be despised and branded with social contempt than the painted creature he is ashamed to recognize on the street the morning after.
The Dangers of Ignorance.
There are three main venereal diseases which constitute the roots of the giant tree of the venereal peril, and from which almost all venereal disorders spring out like branches and twigs. They are Gonorrhea, Syphilis, and Chancroid. The first two easily overshadow in widespread distribution and dangers of complications the third member of the venereal triad, so that Chancroid can be considered by far the least dangerous of the three.
A conservative estimate of the spread of venereal diseases, in the writer’s opinion, would be that from every hundred men, at least ninety have had at one time or another a venereal infection; that from every hundred cases of venereal diseases, not half of them receive a thorough and scientific treatment, not half of the patients are aware of the seriousness of their condition and possibilities of different complications, and only a minority of them bring the treatment to a complete and permanent recovery. Any physician doing genito-urinary work both in a clinic, hospital, or private practice knows that most of the patients take treatment only until they cure up their pains, sores, and other symptoms of the disease, and not until they are completely cured. As it were, they dismiss the physician; the physician does not dismiss them. As a result of this unsystematic and superficial treatment, the original disease recurs again and again, only each time it penetrates a little deeper into the system and requires a longer period of time for a complete cure, with less chances for success. Thousands and thousands of men develop serious and deep-reaching complications, sapping their vitality and undermining their strength, complications which would never have happened if the disease had been treated from the start, thoroughly and to the finish. Still another result of this indifferent and reckless attitude is that thousands of men, believing themselves cured, take upon themselves the grave responsibility of entering marriage, taking a pure and fresh girl, the girl they love and revere with all their hearts, trusting and unsuspecting of the terrible danger hovering over her head. The disease-producing germs that have been weakened and stunned but not killed by insufficient treatment, falling on a virgin and fertile soil, take on a new lease of life, and with the fury of a devastating tornado attack and ruin their new victim. A young bride often before the honeymoon bliss is over is struck down with an acute infection, a mutilating operation follows, and in a few months a beautiful, healthy girl is transformed into a permanent invalid and nervous wreck, deprived forever of beauty, health, and joy of life. This terrible tragedy is not an exceptional case, it is not an overdrawn statement, it is an every-day occurrence in medical practice, and every day adds its new victims of men’s folly, criminal indifference, and recklessness born of ignorance.
Self-Medication and Medical Quacks.
That the average boy or man has not the slightest idea about all the possible complications that may develop from a venereal infection is best shown by their attitude in time of such venereal mishap. What is an average boy doing when he discovers that he is a victim of a venereal mishap? The very first thing he does is to confide his shocking surprise to one of his companions, who he knows has already had a similar experience. The experienced friend first gives him a hearty laugh over his bad luck, and then assuming a wise look, pats him on the shoulder and confidently tells him not to worry, as he “will fix him all right.” He gives him a few general instructions, the kind he used to follow in his own previous experience, and sends him to the drug store for a certain kind of pills, capsules, or solutions for injections. If there be no such friend at hand, some other amateur “expert” is consulted; sometimes it is a barber, or even a bartender friend who gives an advice to drive out the sickness by copious drinking of beer. A grade higher in quality, but equally poor and uncertain in results is a consultation with the neighboring druggist, who, not having any more knowledge about the developments of diseases than the average layman, takes up the case with the supreme confidence of an authority and hands over the counter the best advertised pills or solution for injections. The best that can happen to the beneficiary of these consultations is, that he will not see at once any improvement, or that he will feel worse, then he will go to a competent physician and will start regular treatment. But woe to him if he will feel some symptomatic relief, some checking of the discharge or the pains. This is the time when he is the real loser. Fooled by the temporary improvement and by clearing up of the symptoms of his disease into belief that he is cured or pretty nearly cured, and encouraged in his belief by his equally ignorant and often unscrupulous adviser, the patient resumes his former mode of life and discontinues what little precaution or treatment he has been using. The natural result of it is that a few weeks later, after some indiscretion like drinking alcoholic liquors or dancing, the whole sickness comes back as strong and violent as in its very beginning. Again he resumes his treatment and care, and acute symptoms again quiet down until, under a new provocation, the disease will break out once more. Thus trusting and ignorant victims of venereal mishap, wasting time and often considerable money on their amateur doctoring, let the roots of the sickness untouched, allow it to penetrate deeper and deeper into the body and develop some deep complication or permanent damage of the sexual system, which is either incurable or at best requires many months of the most painstaking treatment.
Probably the most pitiful of all venereal patients are those unfortunates who either have no friends in whom they could confide, or who, thru a false feeling of shame, do not care to have a personal consultation, and resort to a treatment by mail thru one of the quack medical concerns. In no other class of diseases, in fact in no other walk of life, is human ignorance, suffering, and fear so cruelly and unscrupulously abused and penalized as in venereal diseases.
Shielded from criminal persecution by the secret manner of dealing with their trusting patrons, secure in their shady operations by the fear of disgrace, and a reluctance on the part of their victims to bring to publicity the fact of their venereal infection, these human vultures ply their extortionate trade on thousands and thousands of men. Most extravagant claims, guarantees of cure, regardless of what the sickness is, most blatant, alluring advertisements and offers of free examinations—these are the stock of trade used by these leeches waxing fat on human ignorance and degradation. Fortunately, in recent years the attention of State and Federal government has been called to the use of the mail by these benefactors of suffering humanity for extortionate purposes. Energetic steps have been taken to curtail and abolish this criminal correspondence game and to close up many of these establishments. Public opinion is aroused on the subject, and it demands that the newspapers refuse and eliminate all fraudulent and alluring ads. of quack medical institutions. In the meantime the campaign of information and enlightenment should be carried on, and every young man should be informed that reckless and indifferent treatment of venereal diseases, self-doctoring, cures by correspondence, and “sure cures” by medical quack institutes may prove as disastrous as the disease itself.
Prostitution.
Considering the sources of venereal infection and the best possible methods of control of venereal peril, one strikes at once the sinister problem of prostitution. Prostitution is undoubtedly the main source of venereal infection, but the term prostitution should be taken broadly. There are two kinds of prostitution: one is openly organized in red-light district, tolerated by society, and regulated by the police; and another, secret, clandestine, practised by thousands of women and girls in large towns, women who do not make a living from the “life of shame,” but secretly indulge in illicit sexual intercourse for a side income or presents, while trying to keep up an appearance and social standing of a “respectable” woman. Which kind of prostitution is more dangerous to morals and health is not settled.
Many medical and social authorities believe that a woman secretly prostituting herself is more dangerous and more liable to spread venereal infection than an open registered prostitute, just because she is secret, and does not have to submit to medical inspection at any time. Yet it must be admitted that the medical inspection of houses of prostitution has failed to bring about the expected results and to give protection from venereal infection. It is well established that every prostitute is infected with gonorrhea or syphilis, and mostly with both, and that they practically at all times carry this disease in active or latent form. The degree to which they can transmit a venereal infection to a man depends mostly on the stage of the disease in the prostitute at the time of her visit by a man; that is, one time danger is greater than at another, but at no time the perfunctory medical examination given to prostitutes as it is conducted under police regulations can give the slightest guarantee of safety from venereal infection. All it can establish and claim is that no acute or active symptoms or lesions have been found on examination, and that there is no urgent necessity to move this woman to the hospital as an evident and prolific source of venereal infection. In other words, medical inspection can single out and isolate a few of the most flagrant and most evident cases of venereal diseases, but the women not excluded by medical examination from plying their trade are just as able to carry over venereal infection to a man as their sisters removed to the hospital. In fact, the reduction in the number of venereal infections because of isolation of a few most flagrant cases is so slight, and the increase in the number of venereal infections due to increase in numbers of exposures by men, who are misled into a feeling of security by alleged medical inspection, is so great that many medical authorities and sanitarians consider medical inspection of houses of prostitution useless and even harmful.
As mentioned above, a “secret” prostitute and private lady friend is not a bit more safe and secure from transmitting venereal infection, and in many cases, contrary to the expectations and beliefs of men, are much more dangerous and treacherous in this respect. It is almost humorous, if it were not so pathetic, to see how dumbfounded and shocked are these youthful transgressors of the forbidden path, when a physician declares that the exceptional favors of their lady friend resulted in a bad case of gonorrhea or chancre. They are sincerely indignant at the reflection on the honor of their affinity, and are almost ready to doubt the competency of the physician, until a microscopical examination and the subsequent course of the disease convinces them of the sad truth. On occasions of this character a man as a rule is always inclined to blame the woman and accuse her of gross deception. Such attitude is entirely wrong, and is based on the ignorance of clinical facts. The truth of the matter is that while a man can always tell when something is the matter with him, and can always notice or perceive some evidence of the venereal disease, such as a discharge, pains, sores, etc., a woman hardly ever is aware of her disease. In fact, women feel pains, discomfort, and suffer acute distress only in the acute stage of venereal diseases, at the very beginning of the infection. But after this acute period is over, they may sincerely believe themselves well, as no pain or any symptom unusual for them calls their attention to it. Therefore the noble indignation of these trespassers on forbidden ground is unjust and unwarranted, and the only party to blame is their own ignorance and lack of self-control.
The only sure way to avoid a venereal exposure is to avoid the exposure and to keep away from the danger zone.
Practical Prophylaxis (Prevention).
Different methods have been suggested to minimize the chances of venereal infection. One of them is the use of rubber protectors, “condom,” but the protection they give is far from certain, as they occasionally tear, and also the infection may be implanted in parts beyond the protected area.
The United States Army and Navy, as well as some European governments, have introduced some preventive ointments for syphilis and injections for gonorrhea, but these preventive measures to be effective must be applied at once after the exposure, and in a most thorough and careful manner.
Venereal Diseases.
As mentioned before, there are three venereal diseases, which constitute the main bulk of venereal cases, and which are at the bottom and the cause of most venereal disorders. They are Gonorrhea, Syphilis, and Chancroid. These diseases are produced each by a different and separate kind of germ; they develop independently one from another, and they can never change one into another. But they can coexist in one patient; i. e., a man can get at the same time gonorrhea and Chancroid. If this double infection takes place, then both diseases have to be treated at the same time. The fact that a man has already one disease in a chronic form does not prevent him from getting another. Equally so, the fact that a man has already once had a venereal disease does not prevent him from contracting it a second time, nor does it make it less likely to occur. This is particularly true in the case of gonorrhea and Chancroid, but much less in syphilis, in which an infection for a second time is rather rare.
Prognosis (Prediction as to the Future Development) of Venereal Diseases.
The popular mind usually estimates the danger, seriousness, and probable duration of any disease by the amount and intensity of pains, by the violence and rapidity of its development, and by the degree of disability that the sickness inflicts on a man. Nothing could be farther from the truth than this belief in the case of general internal diseases, and still more in regard to venereal diseases. The most destructive, most malignant incurable diseases in most of the cases begin slowly, insidiously, without acute and severe pain, hardly attracting the attention of the patient, and for a long time not interfering at all, or very little, with his working capacity. Often the patient wakes up and takes notice of the disease only after it has gotten deeply into his system and holds him in its clutches, never to release him. On the other hand, many acute diseases, that start with a high fever, violent pains, and other alarming and terrifying symptoms to the patient, under intelligent care pass away just as quickly as they come, and leave the patient without any permanent damage. This is particularly true in regard to venereal diseases. Do not judge the seriousness and dangerous nature of a venereal disease by the amount of pain and discomfort it brings to you. In no other respect are the venereal patients as much misled and fooled as in this, and no other mistake brings as much unnecessary and preventable suffering and financial loss. Only a competent physician, after a careful observation and repeated examination with the special methods, can give a correct estimation as to the danger and probable duration of the disease.
Remember also that the best and most learned specialist cannot promise you a perfect cure in a specified time, but he can give you only a probable duration of the disease, liable to be changed by many unforeseen circumstances; and keep away from a man who “guarantees a sure cure” in so many weeks or months. The treatment of venereal diseases can never be forced and hurried thru in a certain period of time, and those patients who insist on a doctor’s pushing the treatment in forced marches always strike a bad bargain and are doomed to disappointment by a relapse of the disease or the development of serious complications.
Gonorrhea.
Gonorrhea, commonly termed a clap, is unquestionably the most widespread of venereal diseases. So common it is, so insidious and deceiving in its appearance, that most men fail to realize its serious and often dangerous nature and regard it as a trifling affection. How often one hears boys repeat this hackneyed and silly expression, “I would rather have a clap than a bad cold.” What childish recklessness, what arrogant ignorance, and how terribly it is punished and regretted later on!
The more medical and social workers study the clinical and social ravages produced by gonorrhea and its complications, the more they are impressed by its enormous and far-reaching destructive power on human health and happiness. It is a wellestablished opinion among the medical scientists at the present time that the total amount of damage and suffering to individuals and to society at large produced by gonorrhea falls not far below that produced by Syphilis, which is justly known as a black scourge of humanity. Gonorrhea is considered now a very serious disease, requiring, for a complete and permanent recovery, long and painstaking treatment. The complications of gonorrhea are numerous and far-reaching. Ninety per cent of inborn blindness in children in institutions for the blind are due to Gonorrhea, and tens of thousands of little sightless victims are a pitiful evidence of the disastrous consequences following the neglect or indifferent handling of Gonorrhea cases. It is also known that possibly half of all operations performed on women are due to neglected or unrecognized cases of Gonorrhea, and thousands and thousands of young women become permanent invalids thru the ignorance or indifference of their husbands. Only a Genito-Urinary specialist, who sees how many of these cases are mistreated or untreated because they are regarded by the patients as trifling and not worthy of any particular attention, who sees how these cases, once the sickness takes deep roots in the body, drag on for months and months in spite of the best treatment; only a physician can realize to the full extent how seriously and carefully each case of Gonorrheal infection must be handled. The respect and fear of Gonorrhea comes to young men only after a sad and distressing experience as an afterthought. How much better it would be as a forethought. It is the writer’s hope that the following lines will serve as a torch of knowledge, shedding light and guiding to safety the traveler through the darkness and dangers of sex ignorance.
Diagnosis (Recognition of Gonorrhea).
Gonorrhea is an inflammation of the lining of the urethral canal, produced by a certain kind of germ called Gonococci. These germs are so small that millions of them can be found in one drop of pus (matter), and they can be seen under a microscope grouped in pairs, and resembling in shape the halves of coffee beans put together. Gonorrhea is also called a specific urethritis, which means an inflammation of the urethra caused by a specific germ, to be distinguished from a simple non-specific urethritis, produced by other germs not Gonococci.
There is a great difference in seriousness and possibilities of developing various dangerous complications between real Gonorrhea, i. e., specific and simple non-specific urethritis. Simple urethritis is a mild and harmless catarrh of the urethra, which ordinarily clears up in from one to two weeks with a very simple treatment and even without treatment. Simple urethritis never leads to any deep or dangerous complications, never goes into the blood of the patient, and does not carry over affection to the wife and children. Unfortunately, from every hundred cases of urethritis, the majority of them, not less than ninety per cent, are real Gonorrhea, and the balance of ten cases are simple urethritis. For a man who has contracted a venereal affection of this character it is of greatest importance to determine whether his case is a simple urethritis or real Gonorrhea; but this is not as simple as could be desired, and as most of the patients believe it is. It is absolutely impossible to differentiate between real Gonorrhea and simple urethritis by the clinical appearance of the case or to estimate the seriousness and duration of the case by the visible symptoms, such as the amount of discharge, intensity of pains, etc. Not only the patient, but even the physician can not establish the presence of Gonorrhea in the case without a microscopical examination. A man who claims to be able to estimate the nature and seriousness of the case from the looks of things is either an ignoramus or impostor, or both.
Clinical Course of an Acute Gonorrhea.
The first signs of Gonorrhea usually appear not before two and not later than five days after unclean intercourse. This is the so-called incubation period—a period that differs in length in various diseases. The first thing that attracts the patient’s attention is a slight itching or tickling feeling and a sense of heat in the end of the penis. From twelve to twenty-four hours later a swelling is noticed at the opening of the urethral canal, and a whitish discharge begins to ooze from the canal. This discharge begins to increase rapidly in thickness and amount, and soon a greenish yellow thick pus begins to flow profusely. Correspondingly, the swelling and inflammation increase more and more, and urination becomes more difficult and painful, very often so agonizing that the patient holds the urine as long as he possibly can. Usually it takes from one to two weeks until the sickness reaches its climax, then for a week or two it stands at the same height, and from the third or fourth week it begins to go down, the discharge diminishes in amount, turns to creamy white, then becomes thinner, slimy, the urine becomes clearer and clearer, and in five to six weeks from the beginning of the disease the patient recovers completely. This is the course of a somewhat normal case of Gonorrhea, with smooth, regular development and without any complications. A man must consider himself very lucky if he recovers from Gonorrhea in five to six weeks completely. Only a small minority of all Gonorrhea cases run so smoothly, probably not more than 25 to 30 per cent. The majority of the cases, sometimes in spite of the best treatment and the best care, develop different complications, which increase the duration of the disease for a much longer period.
Complications of Gonorrhea.
In the beginning of Gonorrhea the inflammation is limited to the front part of the urethral canal, but in many cases the inflammation goes in deeper and spreads to the rear part of the urethral canal nearer to the bladder.
Deep Gonorrhea.
Acute deep Gonorrhea is usually brought about by some indiscretion on the part of the patient, such as violent physical exercise like running, jumping, dancing, or it may be also produced by drinking of alcoholic liquors or by strong and improperly done injections at the hands of self-doctoring patients. It develops usually from the third or fifth week from the beginning of the sickness. The first symptom of acute deep Gonorrhea is the increase in frequency and painful urination. The most characteristic feature is that the pains are not felt in the beginning or during the act of urination, but right at the end of it, due to spasmodic contractions of the deep urethral muscle on highly inflamed parts. Another distressing feature is the frequency and urgency of urination, so that the patient cannot hold back his urine for a moment, but has to void it immediately. One more symptom that often misleads the patient into the belief that he is getting better, while in reality the opposite is true, is a rather sudden stoppage of the discharge, which has been rather free. At the same time quite often a drop or two of bloody discharge appears at the close of urination, accompanied with the intense spasmodic pains mentioned above. This combination of symptoms makes the acute deep Gonorrhea a most distressing and alarming complication to the patient, and frequently he wakes up for the first time on this occasion to a full realization of the serious and dangerous nature of Gonorrhea. Acute deep Gonorrhea, under intelligent care, subsides and quiets down in two to three weeks, but for a complete cure it takes from six to eight weeks more, so that all together these cases take from two to three months. The importance of Acute Deep Gonorrhea lies mainly in the fact that it indicates that Gonorrhea Germs have penetrated deep into the system, opening a gateway for other deep and serious complications.
Gonorrheal Inflammation of the Testicle (Epididymitis).
The nearest place for Gonorrheal germs to invade from the deep Urethra is that part of the testicle which consists of the twisted and folded on itself spermatic duct; this part is called the Epididymis, which means the appendix of the testicle. Epididymitis starts usually quite abruptly, from three to five weeks from the beginning, after some physical exertion, like too fast or too much walking, running, jumping, dancing, wrestling, etc. It starts with a high fever, headache, feeling of heat and weight, and agonizing pain in the testicle. Every motion and walking becomes impossible and the patient has to take to bed. The testicle in its rear part becomes swollen, sometimes to twice or even more its normal size, and hard. Under proper care, the acute symptoms of pain and swelling subside in two to three weeks and the patient is able to resume his work, but a part of the swelling and hardness remains and can be felt for many, many months, until it gradually disappears thru slow absorption; yet in some cases a small, hard nodule remains forever. The main danger of Epididymitis is just in this very possibility, that the spermatic duct may be partially or completely obstructed and blocked permanently by the inflammation, in consequence of which no spermatozoa can go out from the testicle of this side, and if Epididymitis occurs on both sides, which happens often, then obliteration of the spermatic ducts is complete; in other words, the man can never have children—he becomes sterile.
Gonorrheal Buboes.
Among acute complications of Gonorrhea should be mentioned also buboes, very much dreaded by the patients, who are pleased to call them, for some reason, “blue balls.” Buboes are a swelling of the glands in the groin, which can be felt as hard and tender knots. Gonorrheal buboes are very harmless, usually go down promptly under treatment, and very seldom form an abscess.
Chronic Gonorrhea (Gleet).
A case of Gonorrhea that lasts longer than three months is called chronic. There is a number of different conditions that may keep Gonorrhea up for many months and even years. Chronic Gonorrhea differs from acute by the absence of pains, swelling, or any other violent or acute symptom. The discharge is either very slight, just a drop in the morning (so-called good morning drop) or none at all. Frequently a man feels no discomfort of any kind and does not notice anything abnormal, except possibly a slight pasting and glueing of the urethral canal, in which cases only a close examination of the urine will show that it is full of shreds; but a large majority of the cases of chronic Gonorrhea is accompanied with more or less copious discharge, commonly called Gleet.
Chronic Gonorrhea may be limited either to the front part of the Urethra or to the deep rear part.
Prostatitis (Gonorrheal Inflammation of the Prostate Gland).
A most frequent cause of Chronic Gonorrhea is the extension of the Gonorrheal infection into the Prostate Gland, which, as mentioned above, lies deep between the Urethra and the bladder. Once Gonococci have penetrated into the deep recesses of the Prostate Gland, they secure there a very strong foothold, and it is very hard to reach and dislodge them with an ordinary treatment. Gonococci may lay dormant in the Prostate Gland, producing very few active symptoms and very little annoyance and discomfort to the patient, who may consider himself well, or pretty near well, and suddenly, after some indiscretion like dancing or use of alcoholic liquors, the germs take a new lease of life and precipitate an acute outbreak of Gonorrhea. The patients as a rule believe that they have contracted a fresh case, while in reality it is a case of reinfection from their own prostate gland. These cases of rekindling of old Gonorrheal prostatitis can repeat themselves many, many times, until the true cause is discovered, and the Prostate Gland is cleaned up thoroughly.
A chronic Gonorrheal Prostatitis is an extremely common infection. Probably not less than half of the Chronic Gonorrhea cases are due to the involvement of the Prostate Gland. The tissue of the Prostate Gland is extremely rich in nerves, and its chronic inflammation, thru the pressure and irritation of different nerve endings, produces pains and discomfort, not only locally in the genital organs, but also far away in different parts of the body. Locally, the symptoms of chronic prostatitis are a whitish, milky discharge from the urethral canal, particularly after urination or defecation (stool), and a deeply-seated feeling of weight or deep burnings. From distant pains produced by the irritation of the nerve endings, most common are pains in the legs, in the back, in the region of the stomach, and headaches. In fact, very often patients come complaining of pains in different parts of the body, without having the slightest suspicion that the cause of it all is their infected Prostate Gland. One of the most distressing features of chronic Gonorrhea prostatitis is its powerful, depressing influence on the patient’s spirit and mentality. No other complication of Gonorrhea wears down a man’s courage, self-assertiveness, and joy of life, none of them makes a patient so disheartened, worried, and despairing of recovery as does chronic Prostatitis. Gonorrheal Prostatitis, under the best treatment, takes usually several months for a complete cure, and the task to keep up a patient’s courage and confidence in his recovery taxes as much the physician’s skill as the treatment itself.
Gonorrheal Strictures.
Next to Gonorrheal Prostatitis in frequency and practical importance should be mentioned stricture. In fact, in many cases it is much more dangerous, as the old neglected stricture can never be cured completely, while prostatitis, even in the old cases, almost always can be brought to a satisfactory condition.
The stricture is a scar, forming gradually and slowly after an uncured Gonorrhea. Usually these scars are a result of row patches in the urethral canal that quite frequently develop during a chronic Gonorrhea. These patches, so-called granulation patches, what the public calls “wild flesh,” are a common source of pains and persistent discharge, lasting for many months. These granulation patches can be discovered only thru a special instrument called urethroscope, which introduces electric light in the urethral canal and makes possible a clear and exact inspection of its entire surface. If these patches are not discovered or not properly treated, they may heal up slowly by themselves, but not in a natural way with the restoration of the normal size and smooth lining of the canal. They will heal up with a scar that has a peculiar ability to shrink and to contract. As a result of it, the normal (lumen) channel of the urethral canal is interrupted, twisted, and obstructed, partially or completely, which leads to a retention or a stoppage of urine. The granulation patches are soft in the beginning, and can be cured without difficulty in very few weeks or months; but after they have turned into a stricture the treatment is immeasurably harder and longer. In fact, the very old strictures cannot be cured completely, but only relieved temporarily.
The main danger of a stricture is its slow and insidious development. It takes many months for a granulating patch to turn into a fresh stricture, and it takes years to form an old stricture. For months and years a patient may have no discomfort nor symptoms sufficient to call his attention to his condition, and by the time he begins to feel some annoyance and to notice some disturbance, the stricture is already old and incurable. Therefore it is highly important for any man who has had the misfortune to contract Gonorrhea to secure a positive assurance that he is in no danger of developing a stricture later. The active symptoms of stricture are: (Gleet), a slimy discharge, particularly in the morning; frequency of urination and a slow, dribbling, weak stream of urine; but, as mentioned above, these symptoms develop long after the stricture is formed, and no man should wait for their development.
Gonorrheal Rheumatism.
The last, and by no means a rare complication of Gonorrhea, is rheumatism. Gonorrheal Rheumatism usually sets in abruptly at any time in the course of disease, and commonly attacks ankle, wrist, knee, or elbow joints. Clinically, it strikingly resembles a common acute rheumatism, but the treatment which is efficacious for the common variety of rheumatism is perfectly useless in Gonorrheal. Gonorrheal Rheumatism is a very serious complication; it causes a good deal of suffering, it takes many weeks or months for a complete recovery, and in many cases leaves behind stiff joints and permanent disability.
Treatment of Gonorrhea.
We shall proceed now to describe briefly the general principles and methods of the treatment of Gonorrhea and its complications, as we believe that the intelligent understanding of these methods will help men afflicted with Gonorrhea to avoid blunders of self-doctoring and exploitation by ignorant impostors and unscrupulous medical quacks. The acquaintance with scientific methods of treatment of Gonorrhea considered the best at the present time should prove conclusively to these men that to protect themselves against dangerous complications and permanent injurious aftereffects of Gonorrhea, they should not trust their health either to friends ever ready with advice nor to the alluring and highsounding promises of quacks; it would show that there is no short cut to a cure of Gonorrhea; that this cure can be effected only by systematic and persistent treatment at the hands of a competent physician.
The first point of importance to remember in the treatment of Gonorrhea is that Gonorrhea is essentially a local disease, and that it penetrates into the blood in the whole system very seldom; in fact, only in one complication, Gonorrheal Rheumatism. This fact readily explains why the main treatment of Gonorrhea is local, and why the internal treatment with drugs is of secondary importance, and in many cases can be omitted altogether. Yet the public at large seems to believe as religiously as ever in the magic power of different potent drugs, such as “blue” capsules, cubeba, copaive balsams, santal oil, etc. This medical superstition unfortunately is encouraged and kept up by manufacturers and dispensers of these drugs for commercial reasons, as well as by many healers disqualified by the law or the lack of special training and equipment.
Treatment of Acute Gonorrhea.
The very first request a gonorrheal patient addresses to a physician is to stop the discharge as soon as he can. Should the physician comply with this request, he would show by doing so not only a complete ignorance of the subject, but he would also do a great deal of harm to the patient himself by driving the disease inside instead of outside. The popular fear of a discharge is based on the ignorance of the fact that the discharge in Gonorrhea, like many other symptoms, such as fever, cough, vomiting, etc., in other diseases, are not harmful by themselves, and that in a certain stage of the disease they serve a useful purpose of helping the human body to get rid of the different poisons and disease-producing germs. So in Gonorrhea the thick, greenish yellow discharge helps along the Nature to throw off and to eliminate Gonococci, and until this purpose is accomplished, to check a discharge is not only unnecessary, but absolutely harmful. Therefore, in the early stage of Gonorrhea intelligent treatment calls for injection with antiseptic drugs that kill Gonococci and rather stimulate a discharge than check it. Only later, in from three to four weeks, when the character of the discharge shows that all Gonococci are already eliminated, and that therefore the discharge has outlived its usefulness, only then the physician is justified in giving injections with the binding or astringent drugs, that check and gradually stop the discharge.
Ignorance or a deliberate violation of this rule in a foolhardy attempt to make a short cut to a cure has caused, in thousands and thousands of cases, a penetration of Gonorrhea into the deeper organs and has led to numberless complications and injurious aftereffects.
The injections can be started usually at once, with the exception of the few very acute cases, where the swelling and pains are so severe that it is necessary to wait a few days before starting the injections. It is in these cases particularly that the use of the internal drugs, usually mild antiseptics, is advisable until local treatment can be started. In making injections, one point should never be overlooked: this is, to urinate each time before making an injection; failure to do this has driven many gonorrheas into the deeper parts.
Diet and a General Regime in Gonorrhea.
The dietetic and general regime in an acute Gonorrhea is just as important as the medical treatment. In the first three to four weeks as much rest and quiet as a patient can possibly secure is a very important condition to prevent injurious complications. Too much or too fast walking, running, jumping, dancing, wrestling, etc., should be absolutely prohibited. A well-fitting suspensory bandage should be put on at once. That alcoholic liquors are tabooed is pretty well known to the public, except a very few tyros that still believe that beer can drive out the disease. All stimulating drinks, like coffee, chocolate, strong tea, and sharp seasoned food should be avoided until the acute stage is over. Drinking of plenty of plain water should be encouraged, as the resulting copious urine provides a natural and most efficient drainage and elimination of the dirt of the urethral canal. Less meat and more milk and cereals is the best diet for an acute stage of Gonorrhea. There is no objection to moderate smoking. It stands to reason that any sexual excitement or stimulation is extremely harmful and aggravates the condition immensely. Absolute cleanliness must be insisted upon, and the patient must be careful not to spread the disease by soiling with gonorrheal discharge different articles of personal use that may be used by others. He must be careful also not to carry over a gonorrheal poison with the soiled fingers into his own eyes, as gonorrhea of the eye is a most dangerous disease that often leads to complete blindness.
Treatment of Gonorrheal Complications.
The closing stage of acute Gonorrhea is the only time when a patient can be allowed to take a part in the treatment by making injections at home after careful and personal instruction by a physician. All the rest of the course of Gonorrhea and its various complications can be handled by a physician only, as it requires a special equipment and a special technic.
Deep gonorrheal inflammation forbids any instrumental treatment. With the first symptoms pointing to its development, all injections must stop until the acute stage is over. The patient is advised to rest, and is given some soothing internal medicine. After two or three weeks the local treatment may be resumed.
Similarly to it is treated Acute Epididymitis (inflammation of the testicle). With the first signs of its development, all injections must stop, and the patient has to stay in bed until all acute swelling and pains are gone, which takes usually from two to three weeks. Locally, cold in the form of ice bags, or heat with the hot-water bottle, are used. They are both good, but in either case the applications have to be kept up persistently. Their selection depends upon individual preference and feeling of relief experienced by the patient. Locally, different ointments are used to reduce and soften the swelling.
Deep Gonorrhea can be cured only by deep injections, with a special instrument called instillator, of a few drops at a time of strong germicide drugs.
Extremely useful also and commonly used are irrigations with a fountain syringe of large quantities of antiseptic and soothing solutions, which fill up the bladder and effect a thorough flushing of the whole urethral canal. These irrigations are used under most variable conditions, and are often used preceding or concluding instrumental treatment. Their efficacy depends on the systematic and persistent use and a careful and exact grading of the strength of the solutions.
Granulating patches or row spots mentioned above as the source and origin of strictures can be treated only by the urethroscope described before, by localizing them and touching them up with cauterizing medicines. This treatment is supplemented by stretching with the steel sounds and irrigations. The treatment of strictures is very similar to this, and mainly consists of stretching with gradually increasing in size sounds and irrigations.
Finally, Prostatitis is treated mainly by massage of the prostrate gland, which is done by a finger inserted per rectum. This massage, made once or twice a week, is one of the most valuable parts of the treatment of chronic Gonorrhea, because in no other way can pus and gonococci be eliminated and carried out from the deep recesses of the gland as thru massage. Prostatic massage is usually followed by instillations or irrigations.
Prognosis (Probable Duration and Curability of Gonorrhea).
Treatment of all deep chronic complications of Gonorrhea takes usually from two to six months, and sometimes longer if the case is neglected. Patience and persistence in treatment is an absolutely indispensable condition for success, and patients who take treatment for a while and then drop it because, in their opinion, their case is incurable are throwing away their only chance of cure. The fact of the matter is that chronic Gonorrhea, if treated properly and patiently, can be considered a thoroughly curable disease. The incurable cases make up not more than 5–10% of the total number of cases properly treated, and these few exceptions are usually neglected old strictures, which of all Gonorrheal complications are the hardest to cure.
Gonorrhea and Marriage.
After the treatment of chronic Gonorrhea is completed; after all visible signs and symptoms have cleared up; after the patient has resumed, with the permission of his physician, his usual mode of life, a momentous question comes up before the patient—when can he marry with an absolute assurance that he will not transmit his sickness to his wife; in other words, when can it be stated that he is absolutely cured? That the answer on this question may mean happiness or misery in life for the patient is realized and recognized by all intelligent people. But it seems to be unknown and commonly overlooked that to give a positive and definite answer to this question is a matter of great responsibility and of greatest difficulty, even to the most experienced and highly-trained specialist. Only those who know how treacherous are gonococci, what ability they have to lie dormant for many months or even years in the deep recesses of the body and then on some provocation to waken up to new activity, only those know how hard it is to get the system rid of them, and how difficult it is to be sure of their complete elimination. And yet almost in all cases a physician is able to tell with reasonable certainty whether the patient is able to get married without danger of transmitting the infection, but to arrive at such a definite conclusion a physician must undertake a whole series of different examinations and special tests, as only repeated, persistent, negative tests for Gonococci can be accepted as conclusive. A man who comes to a physician and insists that the physician should render his verdict at once demands the impossible, and the hasty conclusion he will force out is not worth much.