Chapter 10 - Venereal Diseases
Introduction to Venereal Diseases

10.4 Clap

Clap. Gonorrhea. Blenorrhagia.

The reader is aware that the nose, mouth, and lungs are lined with a mucous membrane, which is liable to become inflamed from various causes. This inflammation we call a cold or catarrh. During its continuance, mucus and other matters, of different colors and degrees of consistency, are more or less freely discharged.

The mucous membrane of the private parts of both sexes is just like that of the mouth and throat, and subject to similar inflammations and discharges. But these inflammations of the private parts, instead of being produced by change of weather, etc., generally result from the application of the specific poison or germ microbe of gonorrhea. When a woman abandons herself to unlimited intercourse with different men, the private parts become stimulated to so unnatural an extent, that the secretions of the parts, which are largely augmented, at length become altered in their nature, acrid, and finally poisonous, so acrid and poisonous that they cause inflammation of the parts, and when brought in contact with the male organ, in the sexual act, they poison and inflame that. The specific germ of gonorrhea is called the gonnococcus.
This is the shortest and plainest explanation I can give of clap. From this explanation, one may learn why a man will sometimes take a disease from a woman who has never had any evidence of being diseased herself. If she have indulged her sexual propensities unreasonably, though not enough to produce inflammation upon herself, her secretions may yet have become acrid enough to poison one whose organs are delicate and sensitive. And more than this, the secretions of a female may become acrid and poisonous from other causes than excessive venery. The discharges in bad cases of whites will sometimes irritate and inflame the male organ, and induce a disease which has every appearance of gonorrhea. A husband, in great distress of mind, sometimes submits a case of this sort to the physician's inspection, and lays upon him the delicate and responsible duty of deciding whether the wife has been unfaithful. No act in a whole professional life can be more momentous than a decision of this sort. If a man be well skilled in his art, he may give an answer in such case, which shall dispel the most terrible apprehensions, and save the peace of a loving family.
The poison, when communicated by a diseased person to the male or female organs, requires a certain time for the germs to produce their peculiar effect, generally from three to eight days.

Symptoms. The first symptom of the disease is uneasiness in the end of the penis, accompanied, generally, with a little redness, and difficulty in passing water. The color of the first discharge may be white or straw colored. There is tenderness where the parts are red. Scalding in passing water is sometimes, not always, present at first.
This is the beginning, or first stage of clap. Now is the time to cure it easily. But, unfortunately, the physician seldom sees a case in this early stage. Before he is allowed to inspect it, the second stage has generally appeared, which is known by violent scalding when water is passed, by chordee, or painful erections of the penis, and by an increased discharge of greenish matter often tinged with blood, and coming from much farther down the urethra, or water passage. The matter sometimes comes from as fax down as opposite the scrotum, or bag which holds the testicles. There is more or less pain the loins and back. The whole body of the penis may become affected, and abscesses form.
A third and more terrible stage of the disease begins when the inflammation has reached the lowest part of the water passage, just where it enters the bladder. Around this part of the passage, and lying upon the bladder, is a gland in size and shape like the largest chestnut. It is called the prostate gland. On either side of it lie the receptacles of the semen, each of which sends its duct into the water passage. When the inflammation extends through this gland, it irritates the neck of the bladder, and causes a distressing desire to pass water; and from its proximity to the larger bowel, it sends its irritation thither likewise, and impels a terrible effort to evacuate the bowels, called tenesmus. It is the same awful feeling experienced in dysentery. Few things can be more terrible than these two distressing feelings conjoined, the desire to pass water and to empty the bowels. Racked with terrible pains and awful tenesmic distresses, and often with painful erections, the patient passes back and forth between the bed and stool, often vowing in the sincerity of his heart, that if he can but recover from this, he will never be caught again. The enlargement of the prostate gland may become chronic and permanent, and be the affliction of a man's life.

Stricture. One of the most troublesome and persistent consequences of gonorrhea is a partial closing up of the water pipe, attended generally by quite a serious obstruction to the passage of the water. It is called stricture. The mucous membrane which lines this passage, being long inflamed, becomes thickened and less pliable or elastic. The tissues which lie underneath this membrane also become swollen and hardened, and, pressing upon the water passage, lessen it still further, making the stricture more difficult of cure.
In stricture, the stream of urine is altered in size, length, and force. Its course is changed, when the stricture is lateral. The stream is often flattened, like the blade of a penknife, or twisted like a gimlet, or forked, one stream reaching beyond the other. In consequence of obstruction, the bladder is not entirely emptied, and the desire to urinate immediately returns, and is very urgent.

Gleet. Another very troublesome result of gonorrhea is gleet, a thin, colorless discharge, which persists, in a chronic form, after all active inflammation has subsided. It is very annoying, and very obstinate. It is often dependent on the altered condition of the mucous membrane occasioned by stricture.

Orchitis. Another very severe result of clap is swelling of the testicles, called orchitis. It begins frequently with chills and fever, with a feeling of weight in the scrotum, and pains in the loins. The swelling rapidly increases, and reaches its height in from three to five days.
Besides the above, there are still other mischiefs which follow this disease, such as inflammation of the prostate gland, already described, of the bladder, and of the kidneys.
In the female gonorrheal inflammation affects the external genitals called the vulvoo, the water pipe, the vagina, and the neck of the womb, and often plays havoc with the ovaries and Fallopian tubes. In women the disease is often fatal by ascending the tubes and penetrating to the abdomen, where an acute peritonitis is set up, with the formation of pus.
There is a difference of opinion as to whether gonorrhea ever produces secondary or constitutional symptoms. Ricord, the great French authority on this subject, affirms, and with him a great number of followers, including most of the profession in this country, that constitutional symptoms never follow clap; that they never result from anything but a syphilitic ulcer. Vidal, a French authority, safer, in my judgment, than Ricord, though not as renowned, says, oil the contrary, that secondary and tertiary complaints do follow virulent gonorrhea. Wilson, the highest English authority, and many others, agree with him. Unprejudiced observers feel well convinced that this latter opinion is right. I have myself seen not less than half a dozen cases of secondary and tertiary syphilis, which were preceded by gonorrhea, and nothing more.

Treatment. One treatment is by injection in the early stage. It is not often used except by a physician and consists of the injection of nitrate of silver in weak solution carefully used grain to 2 ounces) or some other silver salt such as argyrol, 20 grains to two ounces injected in teaspoonful doses twice a day. Argyrol is less irritating, less astringent and fully as efficacious as silver nitrate.
The physician should have entire control of the patient, and compel him, if possible, to keep his room, and live for a few days on crackers and water, or something equally simple. All meats and stimulating drinks are to be excluded.
The other mode of treatment, which is perhaps the more commonly adopted, is more general in its nature. It embraces the use of warm baths, warm sweating drinks, and rest. These things, with a low diet, will frequently reduce the disease in a few days. If the discharge should continue, after a fair trial of the above, then copaiba and cubebs (272) are to be used. Several ‘articles are added in the above prescription, to make the copaiba acceptable to the stomach. This preparation can be taken by most persons, and generally produces very gratifying results. Vidal strongly recommends an electuary, or thick paste (273), of which a piece twice as large as a nutmeg is to be taken in the course of the day. The prescriptions which contain copaiba and cubebs are numerous; but the above two are as good as a hundred. With these articles, the baths, the leeches, and the re,. pose, are to be united.

Vidal says he never resorts to injections first, but employs the anti-inflammatory course first. If that fail, then he uses the injection (207), three or four times a day; and if he employs the nitrate of silver at all, it is only as an astringent (208). Prescription, (304) is a valuable injection.
When the second stage sets in, and the symptoms become more violent, injections must not be used. For the very severe scalding in passing water, which is now felt, take thirty drops of a solution of potassa in half a tumblerful of water, twice or three times a day. Persons of full habit may be benefited by dissolving a grain or two of tartar emetic in a tumbler of water, and taking to the extent of producing a little nausea. Relief is occasionally obtained by holding the penis for some time in warm water.
For the painful chordee, or erections, camphor and opium (120) are required, from one to three pills a day. Thirty drops of laudanum may be given when the patient retires. Cold applications to the genital organs, or walking barefooted upon the cold floor, will frequently give relief. When other things fail, three pills a day may be taken of extract of hyoscyamus, containing from one to four grains each. The quantity of drinks must be diminished, and cold lotions must be applied to the penis on going to bed, the patient covering himself lightly.
It must be borne in mind that the quacks depend on strong injections to stop the discharge, but they almost invariably cause stricture which is worse than the original disease and that the average time that will elapse before a cure is effected may be from four to six weeks.
Gleet is generally very obstinate, and often requires a very protracted treatment. If there be any tenderness along the under side of the penis, recipe (272) will be good. But gleet is an unhealthy action, sustained by habit, and may often be cured by simply exciting a new action which shall break the old habit. It is always well, therefore, to resort to injections. Sugar of lead and sulphate of zinc (207) answer a good purpose,,; or sulphate of zinc and tannin (209) may be tried. Chloride of zinc (210) does well in some obstinate cases.
But gleet is often dependent on stricture, and when this is the case, we must learn the location of it by exploring the water pipe with a bougie. When the instrument reaches the constricted part, the patient feels pain, or the surgeon meets an obstruction, often both. When the stricture is found, it is either to have the solid nitrate of silver applied to it with an instrument called the porte caustique, or a solution of nitrate of silver (211), or of acid nitrate of mercury (226), with a shower syringe. When these means fail, we must pass a small bougie gently through the stricture; then a larger, and then a still larger one, until the obstruction be removed. They should be used once or twice a day, and not be retained long in the passage. They frequently have to be used ten or twelve weeks, and should not be discontinued till the cure is complete. Put no confidence in those quacks who promise to cure these old troubles in a few days. They want your money, but have no expectation or ability to cure you at all.
For inflammation of the testicles, apply leeches at once. To this should be added warm fomentations and poultices. If these means fail more serious measures are to be adopted, which it would be out of place to describe in this book.
Inflammation of the prostate gland is also to be treated with leeches and poultices; likewise a warm hipbath. ' The water must be drawn off with a catheter until it can be passed in the natural way.

Prevention of Sexual Diseases. I have several times been in doubt as to the best method of presenting some of the topics which the wide scope of this book has brought before me; but no one subject has perplexed me like the one announced in the above heading, not that it is not easy enough to furnish the rules for preventing venereal disease, but that it is a grave question in morals whether to instruct the world in the methods of such prevention is right. Is it proper to give any other advice than the simple direction to abstain from all liability to disease? That is the question.
If such advice would be heeded, of course no other should be given. But it would not. If the person disregarding it would alone suffer the penalty of the transgression, it might then be best to embody the whole advice in the simple imperative word, abstain! But this cannot be. The infection will be imparted to a third person, and onward to thousands; and many of these thousands will be innocent wives, who will perish of the disease, or send the infection down to the second, the third, the fourth, and to all generations I While a strict morality might seem, therefore, at first view, to forbid the inculcation of rules for avoiding infection, the good of the race would appear to justify and require it.
The first requisite for prevention is cleanliness. Frequent washing is of prime importance.
The precautions should not be the same before and after the venereal act, when a person is about to expose himself to risk. Before the act, the parts should be carefully examined to see ff there be any break in the skin. The least breach in this covering of the penis greatly promotes contagion. Before coition, there should be no washing with soap, for this deprives the parts of the mucus and oil, thus rendering the naked and exposed skin liable to infection. On the contrary, to apply a solution of alum, tannin, or a decoction of oak bark, or aromatic wine, constringes or hardens the covering of the organ, and renders contagion more difficult. An article called condom is often used to ward off disease. It is a sack made of goldbeater's skin, and is drawn over the penis like a glove over the finge4 and thus protects it from contact with poisonous matter.
Of still greater importance are prompt measures of prevention after the act. Lotions should be immediately applied to every part of the organ, and in the case of females, should be used as injections. These lotions should be acids or alkalis. A mixture of vinegar and water has been recommended as an excellent wash. Ricord recommends aromatic wine; Malapert, corrosive sublimate (212), in the form of solution. Probably the best preventive is composed mainly of alcohol and soap (213), as recommended by Langlebert.
An exposed person, using any one of these solutions, particularly the last, or, in the absence of all these, washing thoroughly with soap and water, will be likely to escape contagion.
Medical Police. What is called general prophylaxis, or prevention, or medical police, is not a subject of legislation in this country. The moral sense of the American people does not admit its necessity. In Europe, the authorities watch over prostitution. They even go so far as to regulate it. They appoint practitioners, whose duty it is to act as a sort of medical police, and particularly to visit houses of prostitution once or twice a week, and examine all the inmates. When a girl is found diseased, she is immediately removed to a hospital, and not permitted to return until she is well.

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