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Clap - Gonorrhoea.As a result of this it sometimes happens that intercourse during the menstrual period will be followed by gonorrhoea of the severest type. Some women, too, who suffer from the whites (leucorrhcea) cause the disease to appear in men who have intercourse with them ; this seems to result from the irritating nature of the discharge with which such women are affectež. Then, again, gonorrhoea may arise from simple excess in sexual indulgence, that is, from frequent repetition of the act within the course of a few hours. The physician is sometimes called in by the husband of a few weeks' standing to determine whether or not the bride has communicated the gonorrhoea which has attacked him in the second week of his wedded life. In such cases no rash decision or action should ever be permitted until the situation has been explained to the irate husband, who is apt to feel himself outraged in feelings as well as in person. In the great majority of such cases it will be found upon close examination that the disease is merely the result of the youthful husband's impetuosity. While, therefore, we must always remember the possibility that gonorrhoea may be contracted in other ways than by impure sexual intercourse, yet we may lay it down as a general principle, that this latter is the almost invariable source of the affection. Symptoms.-For a few days after indulgence in suspicious intercourse, no signs of disease will be manifest. Usually at some time between the fourth and eighth days after exposure the patient notices an itching at the end of the penis, usually accompanied by a slight burning sensation upon passing water. After this has lasted a few hours, there will be noticed a slight discharge from the urethra, which at first appears only in drops. This discharge is in the beginning of a watery or milky appearance, but in the course of a day or two after its commencement it becomes quite yellow and creamy. If the inflammation be severe, the matter often has a greenish tinge, and there may even be a few drops of blood mixed with it. By this time the passage of urine causes a severe scalding pain, which soon becomes so acute thac the patient dreads the necessity for passing his water ; his distress is aggravated by the fact that he feels the desire to urinate more frequently than is the case in health. In the majority of cases, the inflammation extends only two to four inches up the urethra ; this part of the organ is apt to be quite tender upon pressure and the orifice of the urethra at the end of the penis is usually red and swollen. The pain during the passage of the water is felt most keenly at the point about an inch from the end of penis, though it must not be supposed that the disease is limited to this part of the urethra. If the inflammation extend further back along the urethra, the patient usually suffers considerable pain and a sense of heat around the neck of the bladder ; there is also apt to be a considerable discharge of blood at the end of the act of urination. This discharge of blood is apt to alarm the patient unnecessarily, as the appearance of blood from the inside of the body usually does. He should, however, feel assured that this blood does not indicate that his disease is especially severe, since it merely comes from the inflamed mucous membrane, just as a patient suffering from severe catarrh of the nose often observes a little blood in the discharge upon his handkerchief. One of the most troublesome and painful incidents of gonor rhoea is the obstinate tendency of the penis to erection. This happens without any provocation whatsoever, and is especially fre quent at night. In consequence of the inflamed condition of the parts, the increase in size of the organ renders an erection extremely painful. This condition is commonly termed chordee. In consequence of the pain the patient's rest is broken, so that his health and strength are thereby seriously impaired; in fact chordee is one of the most painful and annoying features of the disease, though it does not indicate any particular gravity. The other feature of gonorrhoea which renders the affection a troublesome one is the necessity for a frequent evacuation of the urine. The bladder is so irritable that the patient cannot retain his urine as long as usual; in fact he is sometimes compelled to pass his water every two or three hours every hour, or even every half hour If he fail to do so, or for any reason is unable to empty the bladder, he experiences the most severe pain in and around the root of the penis and a most intolerable and irresistible desire to empty the bladder. When we remember that the passage of the urine along the inflamed urethra is accompanied by sharp pain, we can readily appreciate the unpleasantness of the situation. Several complications may arise in the course of a gonorrhoea ; the most common of these are inflammation of the testicle and a swelling of the end of the penis. The former complication rarely happens until the fourth-or fifth week of the disease. It is indicated by pain and swelling of the testicle, while the skin over this organ becomes red. This condition of the testicle is extremely painful, since unless the organ is supported by a bandage or otherwise the patient experiences a sense of dragging in the groin which is sufficient to compel him to lie down, and even make him faint. In addition to this the testicle is extremely tender, so that the pressure of the clothing is sufficient to keep up constant pain. The swelling at the end of the penis occurs in most cases of gonorrhoea, especially in those in which the patient neglects to keep the parts clean. Unless he is careful to pull the foreskin back and wash the part thoroughly every day/matter collects under and around the foreskin and occasions irritation of the organ. There may also be some swelling of the parts from the spread of the inflammation to the tissues of the penis outside of the urethra. This swelling may be inconsiderable, and occasion only slight puffiness of the foreskin ; but in some cases this skin is so enormously swollen that it cannot be moved in the natural way. If the skin be once drawn back, while in this swollen condition, the patient is often unable to bring it forward again - a condition technically known as paraphimosis. This condition occasions the patient considerable pain and great alarm ; it is in fact a matter to be attended to, since, if not relieved, the skin may ulcerate or even mortify, so that serious loss of tissue may occur. This dangerous condition of the foreskin will be recognized through the fact that the skin behind the end of the organ is drawn tightly around the penis like a string. Sometimes there occurrs in gonorrhoea a complication similar to that which regularly happens in connection with the venereal ulcer-a bubo. The glands in the groin become swollen and painful, and may even proceed to the formation of matter. This is a comparatively rare complication of gonorrhoea, and happens almost always only in individuals who are suffering from a debilitated condition of the system, or who neglect to keep quiet as much as possible during the course of the disease. In women the symptoms of the disease are quite different in many respects from those observed in men. These differences result from the fact that in women the inflammation affects primarily and chiefly the vagina, and not the urethra as in the male. Hence it happens that women do not usually experience the same pain and difficulty in passing water as men who are afflicted with the disease ; and furthermore the channel from the bladder is so short in the female, and its calibre so large, that even when this passage also becomes affected, as it sometimes does, there is less pain and soreness about the bladder. In many cases gonorrhoea seems to affect only the vagina in women ; this part becomes inflamed, hot, tender to the touch, and to the eye seems red and swollen ; the external parts surrounding the orifice of the vagina may also become greatly swollen. This condition is accompanied by considerable pain, often felt in the back and thighs. After a day or two a discharge begins to issue from the vagina, at first somewhat thin and yellowish, then becoming thick and greenish. If the disease spread to the passage into the bladder - the urethra - the woman experiences, though in a less intense degree, many of the symptoms which have been described as occurring in the male. There is a frequent desire to empty the bladder, and the act is accompanied by considerable smarting and burning pain. If the inflammation remain limited to the vagina, gonorrhoea is not an especially serious disease in the female. But in some cases the inflammation extends upward into the womb and may even proceed from the womb along the tubes which lead to the ovaries - the fallopian tubes. In this case the affection becomes a grave one ; it may even cause death within a few days, and in other cases induces long and obstinate diseases of the womb which may render the patient's life miserable for years. Sometimes the discharge become much diminished but does not cease entirely ; these are then cases of leucorrhcea, or " the whites. " It must not, however, be supposed that all cases of " the whites " have begun as gonorrhoea, since there are many other causes, especially diseases of the womb, which frequently produce a white discharge from the vagina. Gonorrhoea usually lasts four or five weeks. It is possible, if the patient place himself under treatment immediately upon detecting the disease, to cut short the course of the affection to two weeks or even ten days. In most cases, however, the inflammation lasts six or eight weeks; and in many instances the discharge continues for months, or even years. In these instances the inflammation is not so severe as it was at first; there is no pain upon making water, nor is the individual troubled with the erection at night, which constitutes such a painful feature of the disease during the first month. The discharge is slight in quantity, and usually of a thin, watery appearance ; this discharge is generally observed only in the morning upon rising, and is not visible at any time during the day. This obstinate affection is called the gleet y and is one of the most annoying and discouraging features connected with gonorrhoea. The gleet occurs far more frequently in men than in women, a fact which is easily understood when we remember the structure of the genital organs in the two sexes. For in the male the urinary passage is long and narrow, and the escape of the discharge is impeded by various anatomical peculiarities of structure ; in woman, on the other hand, the matter finds free exit, and is not retained as in the male. Hence the obstinate and chronic forms of the disease are less frequent in the female than in the male. Treatment.-When properly and carefully treated, gonorrhoea is a by no means serious affection. Yet practically, it is one of the gravest diseases to which men are subject. This serious character of the affection is largely due to the carelessness and neglect of patients. Most men pay but little attention to a gonorrhoea, or at least but little attention compared with what the affection really demands. Patients do not permit the disease to interfere with the performance of their daily duties ; they regard it as something to be endured for a few weeks, and seem to think that it will take care of itself, and that recovery will necessarily occur without any particular care or attention on their part. It cannot be too emphatically stated that gonorrhoea, when neglected, is a most serious and dangerous affection ; for it is apt to induce not simply the various complications which have been already mentioned as occurring in the course of the disease ; if these were all the danger to be apprehended, the patient might feel reasonably sure of ultimate recovery. But the most serious result of gonorrhoea - one that happens almost always in cases in which the discharge has been permitted to continue for several weeks or months - has not yet been mentioned ; this danger is the formation of a stricture of the urethra. This affection will be described in the appropriate chapter ; it will suffice to say here that strictures are, in the vast majority of cases, the results of gonorrhoea ; and that they constitute a serious menace to a patient's comfort, and even to his life. The stricture develops insidiously, rarely showing itself within two years after the gonorrhoea, and sometimes causing no trouble until five, ten or even more years have elapsed. Yet a stricture is none the less certain to cause the patient much pain and annoyance in the later years of his life. Many a man has died of a stricture which was the result of a gonorrhoea contracted twenty, thirty or forty years previously. These facts are mentioned here to emphasize the possible gravity of gonorrhoea, and hence to impress upon the patient's mind the importance of the most careful attention in the treatment of this affection. It will not do to suppose that the disease will be all over in a few weeks any how, and that it is not worth while to trouble one's self particularly about the treatment. A patient suffering from gonorrhoea should never lose sight of the fact that, however well he may feel, he is the subject of a serious disease which may render his life miserable and even cause his death. The first item of treatment is bodily rest. The prime importance of quiet during the early stages of gonorrhoea can not be overestimated, and is not generally appreciated, even by physicians. Patients continue their usual employment, even when this compels them to be upon their feet, and even to perform hard manual labor. It may safely be said that if a patient works hard, he cannot expect to recover from gonorrhoea in a short time. The importance of bodily rest has been often impressed upon the writer by observing cases in which men suffering from the disease had sustained some accident or injury which compelled them to keep their beds. In such cases gonorrhoea usually subsides in a few days under the most simple treatment, although up to the time of the accident the disease may have been quite severe and obstinate. Another item of extreme importance in the treatment of gonorrhoea is the careful avoidance of everything which can cause sexual excitement. Unless a man can refrain from all indulgence of the sexual appetite he cannot expect that an inflammation affecting the sexual organs can be soothed into recovery. A third object to be attained is the regulation of the diet so as to render the urine as unirritating as possible. It is therefore desirable to avoid stimulating food such as meats and condiments, and it is absolutely necessary to abstain from beer, wines and liquors. Indulgence in a slight carouse has often caused a gonorrhoea which had been nearly cured to return in full force on the following morning. The patient must therefore make up his mind at the very beginning of the disease that he must be a teetotaler not only until the discharge has ceased entirely, but even for two or three weeks afterward. The diet should consist of bland, unirritating articles such as milk, eggs, starchy and vegetable food, and plainly-cooked meat in small quantity. Tea and coffee may be used in moderate quantity without aggravating the difficulty. If the urine can be made unirritating, the patient's suffering will be much diminished, and his recovery correspondingly hastened. To accomplish this he should take a great deal of liquid diet; he should drink water freely, especially some alkaline water. It is also beneficial, though not absolutely necessary for him to take certain bland liquids, such as flax-seed tea or slippery-elm tea. These articles are unpleasant to most palates, and need not be taken unless agreeable to the patient; but it is his duty to himself to take an abundance of water, and he will find advantage in using some effervescing drink, such as soda water, or some alkaline mineral water. If the measures which have been already mentioned-rest of the body, avoidance of all sexual excitement, the use of a bland diet and care in drinking plenty of water-if these measures were faithfully and conscientiously observed, most cases of gonorrhoea would recover within two to three weeks without further treatment. Yet many patients are unable to take the time necessary for following out these directions. The requirements of their business prevent them from remaining in bed for two weeks. Yet they should be careful and refrain from all exercise or excitement wherever it is possible so to do. For such persons it becomes necessary to employ certain medi cines. These medicinei are taken not for the purpose of " purifying the blood," since gonorrhoea is not a disease of the system, but merely a local inflammation in the urinary passage ; the object of these medicines is to render the urine less irritating and to soothe the mucous membrane of the urethra. To accomplish these ends two drugs have been for many years almost universally employed ; these two drugs are copaiba and cubebs. Both of these medicines have one extremely unpleasant feature - their nauseating taste. To overcome this, many devices have been employed ; the most successful is the use of gelatine capsules, by means of which the taste of the medicine can be concealed and yet the good effects of the drug can be obtained. These capsules come already prepared and can be obtained at the drug stores. The taste of copaiba can also be partially concealed by the use of the following prescription: Balsam of copaiba, - One ounce. Peppermint water, - Two ounces. Compound spirits of lavender, - - Two ounces. Mucilage of gum arabic, - One ounce. A tablespoonful may be taken three times a day. The good effects of this drug are most apparent during the first week or ten days of the disease ; at the end of this time, unless the patient has neglected to observe the precautions which have been already mentioned, the smarting pain during the passage of the water will have ceased. After this stage is reached, that is when the smarting is no longer felt, the copaiba will not accomplish so much good, and may be discontinued. Indeed the drug maybe stopped earlier, or the dose of it diminished if the patient complain of sickness at the stomach ; for copaiba is apt to cause loss of appetite and nausea. After the use of copaiba is discontinued, the patient should take some alkaline remedy, in order to keep the urine bland and unirritating. If he prefer, he may employ some of the usual mineral waters which are kept on sale in the drug stores. A less expensive and pleasant, though equally efficient remedy, consists in dissolving one or two teaspoonfuls of baking soda in a glass of water. This may be taken four or five times a day. If the discharge be still profuse at the end of eight or ten days, the patient may and should employ injections into the urethra. These should not be used during the first weeks of the disease, since they will only aggravate the inflammation. Much unfounded preju dice exists as to the use of injections. They have been charged with causing many of the evils that accompany the disease. It is certainly true that in ignorant and unskilled hands injections can cause and have done much mischief. Patients who treat themselves without consulting a physician, and those still more foolish individuals who patronize advertising quacks and " specialists, " frequently suffer much unnecessary pain and injury. A favorite device of such individuals is to stop the discharge in a few days, thus displaying their extraordinary skill to the admiring patient. The fact is that it is a very simple matter to stop the discharge of gonorrhoea by using a sufficiently strong injection ; but this measure will certainly be followed by inflammation of the testicle, and possibly by a stricture. Although such injury can be done by the improper use of injections, yet it is no less certain that when properly used these measures constitute a most important and even essential feature of the treatment of gonorrhoea. So soon as the acuteness of the pain and the smarting have subsided - and this usually takes place, if the patient has been cautious, at the end of eight or ten days or even sooner - the following injection may be used : Sulphate of zinc, - Eight grains. Laudanum, .. - One ounce. Glycerine, ----- Three ounces. Water, - - - - Four ounces. This may be used as an injection four times a day. The patient must always be instructed as to the method of using an injection. In the first place, it is important that he secure the proper syringe. The articles which are commonly sold for the purpose are made of glass and have a long, thin nozzle ; nothing less appropriate could be devised. The only syringe in the market which can be recommended is the one universally employed in the large German hospitals ; it is made of hard rubber, with a conical end, and holds about half an ounce. When the patient is about to take an injection he should first pass his water, and should then inject the urethra with simple warm water of a temperature which feels agreeable ; after this he may fill the syringe with the medicine, inject it and hold it in the urethra for three or four minutes. In using the injection the piston of the syringe should be gently though firmly pressed. If too much force be applied the urethra will be forcibly distended and the inflamed membrane damaged ; if not enough force be used, on the other hand, the fluid will not come into contact with the inflamed surface throughout its whole extent. Probably the best guide as to the amount of force to be used is the feeling of the patient himself ; he should use sufficient force to cause a slight feeling of uneasiness, but not enough to provoke pain. There is no danger of forcing the fluid into the bladder, as many suppose. This injection should be used for five or six days. If at the end of this time the discharge has decreased considerably, the strength of the injection may be increased by employing the following prescription : Sulphate of zinc, - Twelve grains. Alum, ----- Twelve grains. Glycerine, - - - Three ounces. Water, ... - Three ounces. This may be injected as before. The various complications of gonorrhoea also require treatment. First among these is the condition which has been already described as chordee. This is an extremely painful incident of the affection, and one which probably undermines the patient's strength more than anything else, since it interferes so seriously with his rest Chordee can generally be relieved at once by using the following prescription : Bromide of potassium, - - One ounce. Syrup of orange peel, - - One ounce. Water, ----- One ounce. Dissolve thoroughly and take a teaspoonful in a little water half an hour before retiring. If the patient be awakened during the night by the pain, he may repeat the dose. The ointment of mercury may be rubbed along the under surface of the organ every night and morning. If the irritation extend to the bladder, and cause frequent desire for making water, the following prescription may be taken every four hours during the day : Extract of hyoscyamus, - - Four grains. Bicarbonate of potash, - - Four drachms. Camphor water, - - - Four ounces. Take a teaspoonful every three or four hours during the day. In all cases care should be taken to secure regular evacuations from the bowels. It will often be found that the severity of chordee and the frequent inclination to pass water will disappear if a free movement of the bowels be secured at least once every day. For this purpose the patient may take a tablespoonful of the liquid citrate of potash, or a teaspoonful of the " compound licorice powder. " If constipation occur, it will be better to relieve the rectum by a copious injection of warm water than to take a strong cathartic ; for the latter would result in severe straining at stool which causes congestion of all the organs in the pelvis, and tends to aggravate the inflammation in the urethra. The inflammation of the testicle does not usually occur until the third or fourth week of the disease. The best means for preventing this painful and serious accident are absolute rest, the avoidance of sexual excitement, and care in the employment of injections. No medicines can be taken with the hope of preventing this complication. The beginning of this affection is indicated by the occurrence of pain in the testicle, and by a sense of weight and dragging in the groin. So soon as it becomes evident that the inflammation has begun, the patient should remain flat uoon his back, if possible, keeping the testicle supported by a band of adhesive plaster, upon which the organ may rest. If he be compelled to remain upon his feet, the testicle should be carefully supported by a bandage. The so-called " suspensory bandages" sold in the shops are mostly worthless ; if the patient have a soft handkerchief and a little ingenuity, he can devise a bandage which will answer the purpose. The point is simply that the testicle should be supported by the bandage so that none of its weight is suspended in the natural way. The organ should, therefore, be held closely against the body. Some soft cotton should be placed between the skin and the handkerchief or bandage, so as to protect the inflamed organ from injury. During the early days of the inflammation but little can be done to arrest its progress. The patient should remain quiet, as has been already directed, and the inflamed organ should be wrapped in soft cloths wet with hot water. If the pain be severe, the patient may take twenty drops of laudanum in water every four hours. After the acuteness of the inflammation has subsided, that is, after the pain and tenderness are somewhat diminished, the organ may be wrapped in straps of adhesive plaster. It is scarcely possible to direct in words how this strapping should be done. It may be said in general that strips of plaster about fiveeighths of an inch wide and eight inches long may be prepared ; the testicle is then firmly grasped and forced downward from the body until the skin over it is tightly stretched ; one strap is then passed around at the upper end of the organ so as to hold it firmly in position. The other straps are then applied from above downward, each one overlapping slightly the one next above. This operation must be done with great care, and should always be performed by a physician. The swelling of the glands in the groin is an occasional incident in this disease. A slight amount of swelling is not infrequent in any case of gonorrhoea, and the lumps in the groin may even become somewhat tender, especially if the patient is constantly feeling and pinching them to see how much it hurts. But at times one or more of these glands in the groin become actually inflamed ; a lump of considerable size forms, tender upon pressure, and causing acute pain especially when the patient walks or stands. In every case the first intimation of inflammation in a gland of the groin should be the signal for the patient to take to his bed and remain there. The treatment of the enlarged gland is just the same as that of bubo, which has been described in connection with the venereal ulcer. But first, if you want to come back to this web site again, just add it to your bookmarks or favorites now! Then you'll find it easy! Also, please consider sharing our helpful website with your online friends.
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