The condom is a protective membrane, with which the penis is covered before intercourse. We distinguish as “rubber condoms” those made of rubber, gutta-percha, or caoutchouc; and as “cæcal condoms” those made out of the cæcal mucous membrane of the goat or sheep (incorrectly termed also “isinglass condoms”). The cæcal condom is thinner and more delicate, and blunts sensation less, than the rubber condom. The rubber condom, however, is more trustworthy, in respect of durability and its slighter liability to laceration, if the little precaution is not neglected to keep it in a cool place, and to protect it from the long-continued influence of warmth. The habit of carrying about a rubber condom in the pocket for a long time favours its rapidly becoming untrustworthy and easily torn. Cæcal condoms, on the other hand, very readily become fragile and pervious, although the contrary is the common opinion, and they are preferred to rubber condoms in the belief that the dearer article must be the better. Advertisement is exceedingly active in this direction, and every kind of speciality is widely recommended. In England condoms are sometimes sold bearing the portrait of some celebrated person!
The condom is a “general protective measure”—that is, it protects against both gonorrhœa and syphilis, in so far as the latter disease, as is usually the case, is transmitted from the genital organs. All the leading physicians engaged more especially in the treatment of venereal diseases are agreed that the condom, when of good quality, when properly applied, and when removed with care (for in the removal material adhering to the outer surface may very readily give rise to infection), constitutes the very best and most certain of all the protective measures hitherto advocated. It is true that it can be used by men only, but when used by the man it simultaneously protects the woman from gonorrhœal infection, and not rarely also from syphilitic infection.
2. The Instillation of Solutions of Silver Salts.[336]—These serve exclusively for the prophylaxis of gonorrhœa, and are not, therefore, general protective measures. We owe their introduction to Blokusewski, who recommended the use of a two % solution of nitrate of silver. More recently, the albuminates of silver have been preferred, such as protargol in a 10 to 20 % solution, albargin in a 4 to 10 % solution, or a solution of 20 % protargol-gelatine. These solutions can be carried about in small drop-bottles—for example, as the “Sanitas” (silver nitrate) of Blokusewski, the “Viro” or the “Phallokos” apparatus (these are trade names for proprietary preparations—solutions of protargol). All solutions of silver salts must be kept in the dark, and after the lapse of any considerable time, some freshly prepared solution must be introduced, for time and the influence of light destroy their efficacy. Immediately after intercourse and urination, one or two drops of the solution are instilled into the urethra, and a drop or two also allowed to run over the frænum præputii.[337]
The views regarding the value of these protective measures are conflicting. Beyond question, they are less trustworthy than the condom. Infection has been observed in spite of the use of instillations. Above all, however, the continued use of these methods gives rise to disagreeable irritative manifestations in the urethra and may even cause catarrhal inflammation, and thus artificially increase the liability to infection. Hence, these instillations should be reserved for occasional use; habitually, only the condom should be employed.
3. Inunction.—Whereas the instillation of chemical solutions serves to protect against gonorrhœa only, the practice recommended for a much longer time of anointing the penis with a simple fatty material, or with an antiseptic ointment, before or after sexual intercourse, protects against syphilis only. It is obvious that a layer of fatty material covering the penis exercises the purely mechanical function of preventing the passage of infective matters to the skin. It is, however, equally obvious that by the to-and-fro friction during sexual intercourse, especially when this occupies a considerable time, this fatty covering will be rubbed away, so that the virus can find a means of entrance. The protection is thus extremely relative. Still, such authors as Neisser, Max Joseph, Loeb, and Campagnolle, report favourable experiences regarding the prevention of syphilis by the inunction of the penis, for which purpose simple vaseline, or Schleich’s wax-soap cream, which is sold with the “Viro” apparatus, may be employed. In any case, this method is better than nothing at all. He who has no other protective measure available should remember that in every house there is always some fat or ointment obtainable which can be used for this purpose.
In order, whilst using this method, to protect simultaneously against gonorrhœa, it has been recommended that antiseptic ointment should be inserted into the urethra before intercourse, but this is a very unsatisfactory and untrustworthy method.
Well worth attention is the inunction recently recommended by Metchnikoff[338] of a specific mercurial ointment, after intercourse, for the destruction of any syphilitic virus which may have been deposited.[339] He used for this purpose, not the strongly irritant blue ointment, but the white precipitate ointment, an ointment of the salicyl-arseniate of mercury (enesol), and, above all, a 30 % calomel ointment. After any suspicious coitus, this ointment should be rubbed for four or five minutes into the area of possible infection; this should be done without delay; but even after the lapse of eighteen to twenty-four hours an effect has been traced. The experiments on apes inoculated with syphilis gave positive results; also in the case of a student of medicine who voluntarily offered himself for inoculation with the syphilitic virus, the inunction of calomel ointment appears to have prevented the outbreak of the disease.
In any case, these new methods for the prophylaxis of syphilis demand the most careful attention. Further experience is needed to determine whether they deserve general application.
4. Antiseptic Washes.—Washing of the penis and douching of the vagina with antiseptic lotions (sublimate, lysol, permanganate of potassium) after intercourse are among the most uncertain of protective measures, because the sublimate solution, or whatever may be used, does not find its way into any possible lacerations; and because, in consequence of the profuse secretion of the sebaceous glands of the male and female genital organs, these organs are covered with a layer of fatty material, which prevents the contact of watery fluids, but does not in the same degree prevent the entrance of the syphilitic poison. Antiseptic washes after the sexual act have as little value as the same used before the sexual act.
The knowledge of these protective measures—above all, of those named under the first, second, and third headings—ought to be very much more general than it is. Unfortunately, however, in public life such measures are still viewed largely from the standpoint of the moralist as “indecent” or “improper”; and the criminal law classifies them thus, so that their public recommendation and diffusion is still exposed to great hindrances.