“Now there is to be a fight between syphilis and me. To work, therefore, and courage! Courage, because science assures me that with the aid of mercury, of hygiene, and of time, an end will come to the syphilis, and because science gives me an absolute assurance that some day I shall be as healthy as I was before, and that I shall again have the right to a family, that I shall attain the freedom and the happiness of being a father!”[353]
With these admirable words of the greatest living authority on syphilis, I close my account of the suppression of syphilis by medical treatment, and turn to the not less important question of the management of gonorrhœa.
Recent scientific researches, especially those of A. Neisser and E. Finger, have shown that the infective urethritis of the male produced by gonococci is by no means the “trifling and childish complaint” which it was formerly supposed to be, but, on the contrary, is a very serious and obstinate trouble, often resisting the very best means of treatment, so that it may persist for years, and remain for years infective. Still worse is it as regards gonorrhœa of the female genital organs, the cure of which is even more difficult, and the consequences of which are even more disastrous than in the case of the male. If the physician is needed for the cure of syphilis, still more is this the case as regards gonorrhœa. He only can command the scientific methods, and the very complicated technique of the treatment of gonorrhœa. He only can undertake the indispensable control of the treatment by means of microscopic and other methods of investigation. Every cobbler thinks he can cure gonorrhœa, and yet it is this disease which, even more than syphilis, demands the most precise knowledge of the local anatomical and pathological conditions. Blaschko rightly says:
“While no one gives a damaged watch to a baker to mend, or a torn coat to a tinsmith, every one seems to believe that in order to restore the most valuable gift of humanity, health, it is unnecessary to possess the profoundest knowledge of the human body, and to understand the nature and the causes of the disease. Anyone who has come to grief in his ordinary profession, but who understands how with a brazen voice to denounce the so-called ‘medicine of the schools,’ and to praise with sufficient confidence his own successes, is supposed to possess the wonderful power, without any exact knowledge at all, of charming all the illnesses of mankind out of the world.”
Gonorrhœa is also a curable disease, though curable often with great difficulty. We see this from the fact that, notwithstanding the extraordinarily wide diffusion of gonorrhœa (for a far greater number of infections with gonorrhœa occur than of infections with syphilis), still ultimately the majority of the men, and a large proportion of the women, infected with gonorrhœa are completely cured of their trouble.
The treatment of gonorrhœa is a complicated affair. Within the first two days, by the injection of powerful caustic agents, we are sometimes able to cut the matter short and to put an end completely to the gonococci. In every case the patient, as soon as he perceives a discharge, though not yet purulent, from the urethra, should immediately consult a physician, in order to determine the nature of his disease, which, in the majority of cases, will be found to be true gonorrhœa. If it is not possible to abort the gonorrhœa, then the disease will have to run its course. The best measure, whenever possible, is rest in bed for a week or two, in association with a mild, unstimulating diet, and the absolute prohibition of all alcoholic beverages—the last is indispensable throughout the duration of the gonorrhœa—the drinking of uva ursi tea, and, if the inflammatory symptoms are severe, the application of cold compresses to the penis. Only when the first more severe symptoms have passed away, by which time, owing to the reaction of the urethral mucous membrane, a large proportion of the exciters of the disease will already have been expelled, is it time to begin injections or irrigations of the urethra, containing medicaments the nature of which must be left to the decision of the experienced physician, who will regard each individual case on its own merits. If rest in bed is not possible, the patient must wear a so-called “suspensory” bandage, in order to give as much rest as possible to the testicles and the epididymis, which are gravely endangered in every attack of gonorrhœa. If, as often happens, gonorrhœa ascends to the posterior part of the urethra, or to the bladder, or to the prostate, or if, finally, it becomes chronic, then special methods of treatment, with internal medicines, with local cauterization, massage, distension, medicated bougies, baths, etc., are needful. The cure will ensue very gradually; relapses are frequent; even cessation of the discharge is no certain sign of cure, as the presence in the still turbid urine of “threads” containing gonococci sufficiently proves. Only when the urine has become perfectly clear, and any threads which it may contain are shown by repeated search to contain no more gonococci; when also the prostate, a favourite seat of the last remnants of gonorrhœa, is free from inflammation, can the cure be regarded as complete. Even more difficult is the determination of a cure in women. But persistency in the treatment, and frequently repeated examinations, will lead also in women to the desired goal, or, at any rate, will overcome the capacity for spreading the infection.
In the campaign against venereal diseases by the methods of medical treatment, the facilitation of treatment for the great masses of impecunious persons, for the proletariat, is of great value. For them, above all, the provision of Krankenkassen[354] is needed, and it is very satisfactory to note that during recent years the Krankenkassen have especially directed their attention to venereal diseases, since A. Blaschko,[355] A. Neisser,[356] R. Ledermann,[357] and Albert Kohn[358] drew attention to the duties of Krankenkassen in this relationship in a number of admirable works. Krankenkassen are in a position to obtain exact statistics regarding venereal diseases; to diffuse information, verbally and in writing, to the widest extent among their members; to facilitate hospital treatment, and treatment by specialists; to give medical aid as required to infected relatives of the insured; to carry out regularly every year, once or twice, a medical examination of all members, and to distribute among all these writings on the prophylaxis of venereal diseases. The question also of payment on the part of the patient requires new regulations as regards venereal diseases.[359]
Finally, it has been recommended that, in association with the Krankenkassen there should be founded “daily sanatoria” (Neisser), “work sanatoria” (Saalfeld), “ambulatory places for treatment” (Ledermann), and “convalescent homes” (Stern), for members of Krankenkassen suffering from venereal disease, and for insured persons similarly affected. All these institutions would, moreover, be valuable to the community at large.
What admirable results are obtainable by such a systematic treatment of as far as possible all the venereal patients throughout an entire country has been shown by the astonishing decline in the number of cases of venereal diseases in Sweden and Norway, and in Bosnia, where a gratuitous treatment of all such patients at the cost of the state has been introduced. Thus the organized campaign against venereal diseases, which during recent years has been initiated in all the civilized countries of Europe, has led more particularly to efforts in the direction of the sufficient treatment and speedy cure of recent syphilis and recent gonorrhœa.
We pass now to the consideration of the third factor in the campaign against venereal disease, which comprises the duty of the state, the task of social hygiene, and the task of public pedagogy.