With regard to local applications, the repeated employment of leeches, fomentations, and poultices, with the frequent use of the warm bath, and, above all, keeping the testicle constantly supported by means of a bag, truss, or suspensory bandage, will subdue the disease in a very short time, without impairing the functions of the important organ concerned.
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A hardness, however, of the epididymis commonly remains and continues during life, but rarely gives rise to any inconvenience, although this may often be remedied by compressing the testicles with strips of adhesive plaster, as seen in the cut.
Almost every case of inflamed testicle will terminate favorably by strictly pursuing the plan proposed; but when, from any untoward circumstance, the inflammation proceeds to suppuration, the case must be treated like one of common abscess, in which event professional aid should be sought for without delay.
Other diseases of the testicle will be treated upon under a specific head.
To return to the treatment of Gonorrhœa:—On the abatement of all or any of the enumerated symptoms, such as the diminution of the scalding upon making water, the subsidence of chordee, the escape from, or cure of, swelled testicle, phymosis and paraphymosis, warts, crabs, excoriations, &c., the discharge may still continue, though thicker in consistence, and deeper in color: and it is at this period, which I will call chronic gonorrhœa, when all inflammatory symptoms have left, that stimulants may be judiciously given; but it must be borne in mind that relapses often occur from imprudence: and this chronic form requires as much attention as the acute or early stage. (See [article Gleet].)
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Gleet.—Gleet is certainly, as its name implies, a discharge of thin ichor from a sore. Patients usually understand, and medical men usually allow, a gleet to be a discharge from the urethra, which has existed some time, of a whitish color, unattended with pain, and that is not infectious, by which is meant is incapable of producing gonorrhœa. There are several kinds of morbid secretions, the successful treatment of which depends upon a knowledge of their differences. They may be divided into two principal orders—those secreted from the mucous surface of the urethra or bladder, and those which proceed from the various glands-leading into one or the other. Gleet is a term popularly applied to both, but more strictly relates to that which proceeds from the membrane lining the urinary canal. There is great analogy in inflammatory affections between the mucous membrane of the digestive and pulmonary, as well as urinary passages. In inflammatory sore throat, the secretions assume various appearances; there is a discharge of viscid mucus, of purulent matter, or of a thin watery nature; these secretions are dependant upon the amount and duration of the inflammation present. Exactly in like manner may be explained those issuing from the urethra. They are consequently alike modified by treatment, by diet, by rest, and aggravated by a departure from constant care. It is the nature of all membranes, lining canals that have external outlets, to attempt the reparative process by pouring forth discharges, while those which line the structures that have not, effect their cure by union with the opposite surface. It is an admirable provision, else important passages might become closed, and so put a stop to vital processes; and in the other case, accumulations ensue that could not escape without occasioning serious mischief. When, however, disease has existed a long time, the operation of the two kinds of membranes is reversed. The serous,[2] through inflammation, take on the character of abscess, dropsy, or other secretions, and the mucous ulcerate or form adhesions, as evidenced in stricture, or ulceration of the throat or urethra. Gleet may be a spontaneous disease, that is to say, may arise from other causes than infection. It may exist independently of gonorrhœa, and be the result of cold, of intemperance, and of general or of local excess. Its long continuance and neglect, however, renders it infectious, and it also gives rise to ulceration, excrescences, and stricture: and when, from other causes, ulceration, or excrescences, or stricture, are set up, gleet is in return generally one of their consequences. Gleet, despite these various occasions, is, after all, most frequently a remnant of gonorrhœa; and it is very difficult to define the time or point where the one ends and the other commences. Pathologists draw this distinction between the two:—they say that gonorrhœal discharge consists of globules, mixed with a serous fluid, while gleet is merely a mucous secretion. I confess it difficult for a non-professional person to decide which is which, the resemblance, in fact, being so great—a gonorrhœal discharge being one day thick and yellow, a few days afterward thin and whitish, and at one time in quantity scanty, and the next profuse. Gleet assumes nearly the same changes. The best test for distinguishing them is, by regarding the accompanying symptoms. Where there is pain on passing water, bladder-irritability, tenderness in the perinœum or neighboring parts, and the discharge plentiful and offensive, staining the linen with a “foul spot,” it may, without much fear, be decided to be clap; but where the discharge is next to colorless, like gum-water, for instance, and where there is no other local uneasiness than a feeling of relaxation, and where it has existed for a long period, and was, or was not, preceded by a gonorrhœa, it may fairly be called a gleet. Now where does the discharge of gleet come from? Let us recapitulate its causes; first from clap, which is a specific inflammatory affection. It may therefore be a chronic inflammatory state of the lining membrane of the urethra, of greater or less extent; in which case we would call it chronic gonorrhœa, and which would be owing to a relaxed state of the secretive vessels. We know that when a disease exists for a long while, and is one not positively destructive to life, a habit of action is acquired that renders its continuation in that state as natural as its healthy condition. This is the state of the secretive vessels in gleet, arising from gonorrhœa; and hence the discharge is poured forth, instead of the secretion natural to the urethral passage in its healthy order. Secondly, such may have been the severity of a clap, that ulceration of some portion of the urethra may have taken place. The disease may have got well except in that identical spot which, owing to the constant irritation occasioned by the urine passing over it, struggles with the reparative intention and effort of nature, and exists even for years. Thirdly, when stricture is brewing, which will be explained in an appropriate chapter, the alteration going on gives forth a discharge, and, as I have stated in another part of this work, I here repeat, that a long and obstinate gleet, as the slightest examination would testify, rarely fails to indicate the presence of a stricture. Lastly, gleet may be produced by loss of tone in some or the whole portion of the secretive vessels, induced by one or many of the accidents of life, or the various kinds of physical intemperance when they not only weep forth various kinds of fluids, at irregular intervals, which impair the muscular and nervous energy of the generative organ, but render persons laboring under this description of weakness very susceptible of infection, if they hold sexual contact with those but slightly diseased. Hence persons laboring under this form of debility incur what others escape. An individual so circumstanced would receive a taint from a female having leucorrhœa. Very many inconveniences have arisen from this infirmity, giving birth occasionally to unjust suspicions, and creating alarms of the most distressing nature.