But all cases of gonorrhœa are not ushered in with such severity; nor do many, if common cleanliness and quiet only be maintained, experience even the various accompaniments just described, and still fewer would if the following precautions and measures were used.
The plan just laid down, may be called the surgical treatment of gonorrhœa; the following may be designated the Medical. This is divided into two methods—the one denominated the Antiphlogistic, the other Specific. The Antiphlogistic is a term applied to medicines, plans of diet, and other circumstances, that tend to oppose inflammation by a diminution of the activity of the vital powers, whereby the inflammation is subdued, and nature rights herself again of her own accord. The Specific implies a reliance upon a particular remedy, which is supposed at once to set about curing the disease, as, for instance, by giving Bark in Ague—Colchicum in Rheumatism—Cubebs or Copaiba in Gonorrhœa.
Now, both these plans are successful in curing gonorrhœa; but the majority of medical men adopt the former method, inasmuch as although it but quietly conducts the case to a successful termination, still it does so, whereas the specific, in unskilful hands, is often productive of many annoyances, much delay, and not always a cure.
Our plan, however, is as follows: in the first place, I take into consideration the appearance of the patient; if he be strong, robust, sanguine, or of full habit, and youthful—if it be his first attack, and if the symptoms be ushered in with any degree of severity, I invariably and rigidly (where I choose not the surgical) pursue the antiphlogistic course of treatment; if the case be in a person of phlegmatic temperament, of mature age, and the disease be but a repetition of the past, and there be no evidence of physical excitement, I fearlessly adopt the specific. Where, in the third place, I encounter a patient with no very prominent peculiarity, nor with symptoms demanding extraordinarily active measures, experience has taught me the propriety of cautiously combining the two methods—a mild aperient had best always a precede a tonic or a stimulant, in cases where there is a doubt of inflammation lurking in the system; and, recollecting the tendency our complicated organization has, when assailed by a distemper, to become irritable, it is always as important to know when to withhold a remedy as when to prescribe one.
The three following imaginary cases will serve as no inapt illustration of the principles laid down:—
A. B. A man twenty-six years of age, five feet six inches in height, weighing eleven stone six pounds, of a full rounded form—florid complexion, of what is termed a sanguine temperament, and harassed with the following symptoms: profuse discharge in large yellow clotted lumps of gonorrhœal virus—intolerable scalding on passing water—great pain at the rectum at the close of micturition—redness and swelling of the orifice of the glans penis, puffiness of the prepuce, a vicious chordee—inclination to headache—a bounding pulse—hot skin, and an anxious mind. Treatment: say first bleeding, then purging; warm bath, saline powders or mixtures, cold lotions to the part, rest, abstinence; the following eve, symptoms will be less severe. Continue the powders, temperance and quiet. In a few days, the discharge will be lessened, the scalding mitigated, the chordee gone, and the fever exchanged for the cool skin of health. The resuscitative powers of nature await only the fillip of some gentle stimulant, and the sick man throws off his mantle for the coronal of health.
B. C. At twenty-three, dark countenance, marked features, well developed muscular form, pulse 66, bilious temperament, accustomed to late hours, hard drinking, and seldom still, and subject to clap. Symptoms: plenteous discharge with but little scalding, and no inconvenience beyond the suspension of ordinary sensualities. Treatment: cleanliness, cubebs or copaiba, injections, a black draught, and half a dozen days’ rest, release him from his quarantine.
C. D. At nineteen, a timid bashful youth, for the first time infected with gonorrhœa, which he had enduringly borne for the last fortnight, having neglected until now to seek professional aid, although cajoled into the purchase and imbibing of some popular “never-failing antidote” for a “certain disease.” Symptoms: discharge cured? right testicle swollen, and treble the size of the other, and excruciatingly painful; frequent desire to pass water, pain in the groin and back, general lassitude, and a feeling of illness all over. Treatment: leeches, warm bath, bed, purging, fever medicines, cold lotions, hot fomentations, low diet and patience, a month’s imprisonment, and a slow recovery. Had the treatment of the first two cases been reversed, the results would have been very different: and had the last sought timely and efficient aid, he would have been spared much that he endured.
However, to particularize the treatment for each symptom; to commence, I will request the reader to remember that on the first appearance of gonorrhœa, attended with an unusual inflammatory aspect, I practise, where permissible, venesection; if the case demand it not, at least there should be administered an aperient; let, therefore, a dose of opening medicine be taken immediately (Form [1]). This is the first step toward reducing inflammatory action—the next should be directed toward allaying the local symptoms, by diminishing the nervous irritability of the urethric passage.
With this view, no plan surpasses that of bathing the penis in warm water, or immersing the entire body in a warm bath. The former should be repeated several times in the day; the latter daily, or certainly on alternate days, so long as the severity lasts.