The first step in a series of examinations to form an idea of the localization, intensity of gonorrheal infection and to gauge the results accomplished by the treatment is an examination of the urine. Even a plain inspection of the urine gives to the experienced eye of the physician a pretty good idea of the localization and intensity of the case. To get the best results, the patient must call early in the morning with the very first urine kept in the bladder over night, for the reason that the frequent voiding of urine during the day continually washes out the secretion, and thus masks the true picture of the sickness. The physician inspects the urine after it has been voided in two or three glasses—so-called two and three glasses test.
A systematic and repeated examination of the urine is one of the most important and healthful procedures in the treatment of Gonorrhea, and no intelligent physician can do without it. In this regard, a word of warning should be addressed to the gonorrheal patients. Let no one fall into the error of playing physician in his own case and try to look at his own urine at home, drawing his own conclusions. This is surely one of the occasions where a little knowledge is worse than none. No matter how intelligent a patient may be in other respects, his attempts to gauge his condition by the appearance of his urine will end disastrously in blunders, causing unnecessary worry and striking terror into his heart without reason.
Among the most common mistakes of this character is to regard the long shreds swimming in the urine for pieces of tissue which come, they imagine, from their decaying organs, while the shreds are nothing but the harmless mucous so-called gonorrheal threads, and the longer these shreds are and the more terrifying they appear to the patient the more harmless they are.
Another common and unnecessary scare is due to a cloudy, dirty-looking urine, often full of sandy-like sediment which in reality is not a result of the sickness, but is produced by harmless salts from certain food or drugs. These two examples should be sufficient to show that for the best interests of the patient the interpretations of the symptoms of the disease should never be attempted by themselves, but should be left entirely to the physician.
The next step after the inspection of the urine is a microscopical examination of the discharge or a sediment from a urine. This test is the most significant of all. If a physician finds under the microscope typical gonococci even once from so many times, the patient cannot be pronounced cured and free from infection, no matter how well he feels and how successful are all other tests.
If a microscopical examination of the discharge and of the sediment of the urine is negative, i. e., gonococci are not found, then the physician must secure thru massage a secretion of the prostrate gland and seminal vesicles and examine these fluids under a microscope for gonococci. Even this is not sufficient, and the search for hidden gonococci can be made still more effective by a bacteriological test, which consists of producing an artificial growth of gonococci from a discharge. This test is extremely sensitive, but it is complicated. To assure still greater positiveness of the judgment, a so-called provocative test can be used. The patient is allowed not only to return to his normal mode of life and unrestricted regime, but for experiment’s sake is even allowed an excessive indulgence in stimulating food and drink. Here should be mentioned the so-called “beer test,” which is based on the fact that beer has a peculiar irritating and stimulating influence on gonococci, bringing them from the deep recesses to the surface, where they can be easily found on microscopical examination.
If all these tests are uniformly negative, then the patient can consider himself cured and free from infection, and can be allowed to marry. But if a single one of these tests are positive, that is, shows the presence of gonococci, and the rest of the tests are negative, then the case is still under suspicion and requires further watching or treatment.
It is proper to state, tho, that in certain cases a man may be allowed to marry even before he is perfectly cured from all after-results or complications of Gonorrhea. This is particularly true in regard to strictures, chronic prostatitis, or hard nodules remaining in the testicles after Epididymitis. The reason for this allowance is that the contagious stage of Gonorrhea does not last always thruout the whole course of the disease. Quite often the gonococci are dying out before the after-results and different inflammatory conditions (that were originally started by gonococci, but later were kept up by other germs always present in the genito-urinary tract) are cured. Therefore if a physician, after having tried all the above-described tests, is satisfied that there are no more gonococci present and detectable, and that the condition as yet uncured, such, for example, as a stricture which carries no germs and precludes every possibility of transmitting infection, then he can conscientiously allow the patient to get married, if marriage, for some personal reasons, can not be delayed. At the present stage of medical science the tests establishing the fact of perfect cure of Gonorrhea is a time-consuming and complicated procedure, but considering the responsibility involved both for the patient and the physician, no intelligent man should fail to go through it, if it should fall to his lot to do so.
Functional Sexual Diseases.
After briefly reviewing the problem of Gonorrhea in its different aspects, we shall discuss certain conditions which stand in very near relation to Gonorrhea. There are: Impotence, known under the common name of loss of manhood; sterility, loss of procreative power; and sexual neurasthenia, nervous debility developed on sexual ground. While these conditions may also develop independently without any Gonorrhea in the history, from other abuses and irregularities in the sexual sphere, yet in a very large number of cases they do develop, if not because of Gonorrhea, at least after it; in other words, Gonorrhea, by weakening general and specially sexual nervous apparatus, creates a certain predisposition for their development.