Thus, then, we may have gleet from gonorrhœa, gleet from ulceration, gleet from stricture, gleet from debility and discharges, popularly understood to be gleet, but in reality glandular secretions, which will be considered shortly and separately. Gleet is a tiresome and troublesome disorder. So difficult, occasionally, is its management, that oftentimes the more regularly a patient lives, and the more strictly he conforms to medical regimen, the more deceptive is his disorder. He will apparently be fast approaching to, as he conceives, a recovery, when, without “rhyme or reason,” the complaint recurs, and hints that his past forbearance has been thrown away. It would be dispiriting, indeed, were every case of gleet to realize this description; but it is well known that many do, either from neglect or mismanagement. Now it must be evident that the treatment of gleet depends upon what may happen to be the occasion of it. Where the membrane of the urethra is entire, internal remedies may, and do avail. Copaiba will achieve wonders; the use also of a mild injection, perseveringly employed (as a solution of iodide of iron, or citrate of iron, ten grains to the ounce of water), will give tone and stringency to the weakened vessels, and so correct the quantity, at least, of the secretion. In very obstinate cases, stronger injections, as of the nitrate of silver, twenty grains to the ounce of water, are serviceable; and we are not without many useful internal medical combinations, which, properly administered, conquer this troublesome complaint. In ulceration and stricture, these two causes must be removed, else all efforts are unavailing. In general and local debility, the attention must be devoted to the constitution. Common sense and common reading must give to persons, possessing both, every necessary information. The community are beginning to appreciate the advantages of temperance, air, and exercise, too highly, to need instructions how much of the one or either of the other two are essential to the preservation or recovery of health.
Morbid Irritability of the Urethra.—Of the varied symptomatic sensations, few are more provoking and fretting than some continued troublesome itching or pain that frequently attends the passing of water. There may be no discharge of any kind, but there is either a constant tingling, partially pleasurable sensation, drawing the attention perpetually to the urethra, or there is felt some particular heat or pain during the act of micturition. These feelings do not always indicate a venereal affection; they appear to depend upon local irritation, perhaps induced by a morbid condition of the urine. The treatment consists in temperate diet, moderatively laxative medicines, and now and then local applications. Some cases yield to sedatives topically applied, and alkalies given internally, while others need local stimulants and specific tonics. At all events, whenever there is an unhealthy feeling in those parts, it points out some altered action is going on, which, if not arrested, is likely to end in stricture or gleet, and therefore attention had better be bestowed upon it as soon as possible.
On Stricture of the Urethra.—Of all diseases of the genito-urinary system, stricture must be allowed to be the most formidable. It is not the most difficult to cure; but it involves, when neglected, more serious disturbances—disturbances which frequently compromise only with loss of life. Stricture is a disease unfortunately of extensive prevalence; and in nine cases out of ten is the sequence of a gonorrhœa; and, what is still more comforting, few persons who become the prey to the latter infliction escape scot-free from the former; not because a clap must necessarily be succeeded by a stricture, but simply because it is, and all owing to the carelessness and inattention manifested by most young men in the observances so necessary for the perfect cure of the primary disease. One very prevalent notion, and which explains a principal cause of the extension of the venereal disease, is entertained, that the way to give the finishing coup to an expiring clap, is to repeat the act that gave rise to it: the disease becomes temporarily aggravated, and the impatient invalid probably flies, from an unwillingness to confess his new error, from his own tried medical friend to some professional stranger. From a desire to earn fame as well as profit, the newly consulted prescribes some more powerful means; the discharge is arrested for a while, but returns after the next sexual intercourse; a strong injection subdues the recurrent symptom, which only awaits a fresh excitement for its reappearance. Thus a gleet is established. The patient finding little or no inconvenience from the slight oozing, which, as he observes, is sometimes better and occasionally worse, according to his mode of living, determines to let nature achieve her own cure, and for months he drags with him a distemper that, despite all his philosophy, he can not reflect on without an humiliating diminution of self-approval. So insidiously, however, does the complaint worm its progress, that the patient, considering his present state the worst that can befall him, resolves to endure it, since it appears his own constitutional powers are incapable of throwing it off.
In the midst of this contentment, the invalid finds that the process of urinating engages more time than formerly, the urine appears to flow in a smaller stream, and is accompanied by a sensation as though there were some pressure “behind it.” The act of making water is not performed so cleanly as it used to be; the stream differs in its flow, seldom coming out full and free, but generally split into three or four fountain-like spirts, as the annexed drawing displays.
At other times it twists into a spiral form, and then suddenly splits into two or more streams, while at the same moment the urine drops over the person or clothes, unless great care be observed, as witness diagram.
In advanced cases, the urethra becoming so narrow the bladder has not power to expel the urine forward, and it then falls upon the shoes or trowsers, or between them, as observe illustration.
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