Читать книгу Porneiopathology - Robert James Culverwell - Страница 7

Morbid Secretions and Irritability of the Urethra.—I have stated that clap or gonorrhœa is one of the first and most frequent complaints of the generative apparatus. There are many secretions common to the urethra, such as those afforded by the various glands for the purpose of lubrication, &c.; and the lining membrane of the passage yields a moisture for its own protection, like the membrane of many other organs, such as the eyes, nose, mouth, and so forth, and these secretions may become unhealthy or vitiated, and give rise to symptoms that lead on to confirmed disease; and, what is still more remarkable, may assume many of the characters and appearances of gonorrhœa, but they rarely induce such constitutional disturbances as clap. The symptoms, consequences, and duration of clap, form its distinguishing features from any other discharge of the urethra: it is very important that such distinction should be understood, for the treatment of the two affections differs most materially; the one is an affection of weakness, and the other of an inflammatory and pestilential nature. The symptoms of clap are as follow: there is usually first felt an uneasy sensation at the mouth of the passage or urethra. The patient is frequently called upon to arrange his person; that uneasy sensation sometimes amounts to an itching (occasionally of a pleasurable kind) the feeling extends a little way up the penis; there is oftentimes an erection and a desire for intercourse, which, if indulged in, the sooner develops the disease. The itching alone will not convey the disease from one person to another; but if intercourse be held, the action of the inflamed vessels is accelerated, and a purulent secretion which is infectious is urged forth and emitted with the semen: therefore the very symptom of the tingling or itching, for it rarely exists in healthy urethræ, should be noticed, and intercourse be avoided until it shall have ceased.

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

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

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The glans with some people, is always bare, and the foreskin drawn up around it. Such a state may be induced also by disease: in either case, it may become so inflamed as to resist any efforts to draw it over the glans and, from the swelling and consequent pressure on the penis, a kind of ligature is created; and instances have been known where the most disastrous results have ensued. The circulation of the blood in the glans is checked; the nut puts on a black appearance, and if the ligature be not removed or divided, mortification takes place, and the tip or more of the penis sloughs off or dies away. This state of the prepuce is called paraphymosis: it sometimes happens to young lads, who, having an indicated opening of the foreskin, endeavor to uncover the glans: they succeed, but are unable to pull the prepuce back again. They either take no further notice of it, or else become frightened, but conceal the accident they have committed: in a few hours, the parts become painful, swell, and all the phenomena above detailed ensue.

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

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The next proceeding which will probably be induced, will be an extension of the inflammation to the bladder: the symptoms are a frequent desire to make water, and occasionally ulceration of the membrane lining the bladder follows, when a quantity of muco-purulent matter is discharged, which, mingling with the urine gives it the appearance of whey. Now and then the bladder takes on another form of disordered function: the patient will be seized with retention of urine, that is, a total inability to discharge his water, except by the aid of the catheter. A new and most perplexing feature about this stage of the proceeding is perceived: it is what is called chordee. The existing irritation excites the penis to frequent erections, which are of the most painful nature. The penis is bent downward; the occasion is, the temporary agglutinization of some of the cells of the corpora cavernosa through inflammation, and the distension of the open ones by the arterial blood, thereby putting the adherent cells on the stretch, and so constituting the curve, and giving rise to the pain. This symptom is frequently a very long and troublesome attendant upon a severe clap; it is more annoying, however, than absolutely painful, as it prevents sleep, it being present chiefly at night-time when warm in bed.

Occasionally the glands in the groin enlarge and are somewhat painful; they sometimes, but very rarely swell and break; they more frequently sympathise with the adjacent irritation, and may be viewed as indications of the amount of general disturbance present; as the patient gets better the glands go down, leaving a slight or scarcely perceptible hardness as it were to mark where they had been. The most painful of all the attendant phenomenon of clap is swelled testicle, or, as in medical phraseology it is called, Hernia humoralis.

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

The gonorrhœal poison is capable of producing a similar discharge from other parts to which it may be applied besides the urethra. It has been conveyed by means of the finger or towel to the eyes and nose; and a purulent secretion (attended with much pain and inconvenience, indeed with great danger, when the eye becomes so attacked), has oozed plentifully therefrom. Gonorrhœa is an infectious disorder, and consequently is communicable by whatever means the virus be applied. It certainly is possible, and (if we are to believe the assertions of patients, who are often met with, declaring they have not held female intercourse, and yet have contracted the disease), it certainly is not improbable that it may be taken up from using a water-closet that has been visited by an infectious person just before. It may also be contracted by using a foul bougie.

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

A. The Pubis studded with these insects. B. The Crabs, or Pediculi Pubis, as they are called, about their natural size, as picked from the skin. View larger image

A. The Pubis studded with these insects.

B. The Crabs, or Pediculi Pubis, as they are called, about their natural size, as picked from the skin.

When the gonorrhœa has been severe and there has been much constitutional disturbance, there frequently hang about what are called flying rheumatic pains; and sometimes, if the patient’s health be much broken up, confirmed rheumatism seizes hold of him, and wearies him out of several months of his existence. I have seen many a fine constitution, by a tedious ill-treated or neglected gonorrhœa, much injured, that, had the sufferer consulted a medical man of even ordinary talent, in the first instance, instead of foolishly leaving the disease to wear itself out with the help of this recommended by one, and that by the other, he might have shaken off the hydra, and have averted the hundred vexations that follow.

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

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

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

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

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