View larger image
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.
View larger image
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.