Long Island College Hospital - Lichonian Yearbook (Brooklyn, NY)

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Page --.. - .ms ,..t,,,.,- - ,-.,..t,,...- ----- ---.--,,,--- -- -------fee- P- gg5m.r:sif:'f':.t:::..-,,tg:r.,:-es':te',.. ,,,tg,E,..-eg,,.t-m3F3.f3g::,,.i1fe::rg:f:- , 4 :::t1:e:..zg:ga-,, Cfieniin - lirinarg Biaraara. mf. N considering the history of gonorrhea, it may be stated that inflammations of the urethra are as o-ld as the human race-itself, for we find that Moses, ,Mx i in Leviticus III, describes the disease and gives sanitary and police regula- : gilXC L tions for its control. A X' In 300 B, C., Hippocrates described the disease under the name of strangury, and after making dissections of the urethra, attributed the discharge to tubercles and fleshy proliferations in the canal. He states in his books that those suffer- ing from tubercles and carnosities in their pipe will get rid of the disease by means of the suppuration and How of pus. Aristotle, Plato and Seneca allude to gonorrhea in their writings, and Epicurus suffered so much from stricture and retention of urine that he committed suicide to end the suffering from an attack of retention of urine which had lasted fourteen days. Galen first gave to the disease the name of gonorrhea, believing the discharge to be an involuntary loss, of semen without erection. ln the Middle Ages the disease was described and treated by Italian, French and Moorish physicians, and it was well understood that the disease was contracted through sexual intercourse with unclean women. A truer knowledge of the pathology of inflammations of the urethra was gained through the work of Morgagni. He demonstrated by dissections that the discharge was not caused by ulcerations of the urethra, and he proved the error of Galen's view by showing that the discharge originated from the urethral mucous membrane, and not from the seminal vesicles. He also discovered the lacunae of Morgagni, and indi- cated their importance in cases of chronic gonorrhea. Before the advent of syphilis, gonorrhea was held to be a separate and distinct entity, but in the fifteenth century syphilis appeared in Europe and spread widely and rapidly as an epidemic. This new venereal disease excited so much attention that the study of gonorrhea fell into abeyance, and soon all the venereal diseases became con- fused together and were regarded as different manisfestations of one and the same malady. This period of confusion lasted for two hundred years and would have been cleared up sooner but for the unfortunate and misleading experiment of John Hunter. In order to settle the doubt as to the unity of gonorrhea and syphilis, Hunter inocu- lated himself with a purulent discharge from the urethra of a patient. In the course of time this inoculation experiment was followed by secondaries, namely, an ulcer on the tonsil and a copper-colored pustular eruption on the skin, and from this single experiment Hunter, who was temperamentally quick in arriving at conclusions, drew the inference that gonorrheal pus may produce a chancre and syphilis. In the light of our present day knowledge, it is, of course, obvious that Hunter inoculated himself with pus produced from a chancre concealed in the urethra. In spite of this unfortunate experiment of Hunter's, there were a few physicians, notable among whom was Benjamin Bell, who maintained that gonorrhea and syphilis were distinct diseases, but the erroneous impression that they were one and the same disease, lasted until 1831, when Ricord made 667 inoculations and showed conclusively that gonorrhea and syphilis were two separate and distinct diseases. Ricord's knowl- edge of the causative factor of gonorrhea was uncertain, and he believed that inflam- mation of the urethra was brought about by various indefinite causes. It was not until the microscopic technique of studying bacteria was perfected that the existing cause of gonorrhea was found. fifty-ilirec 'ill in iii il in ' will iii! ia iii, wtf: WH' iii lil iii 5 il bi iii' lf H abil ,IAM ri iii itil iii ll ff M- itll wifi, :rife ,.,413rf,'f4Zxh . ,..,,. N, ., , . 5 ,wr '..gw,Q,. H:-,X M L B an .ily .Qigli ' ' iicaoiiiauti . gigiiqg Z:..:liI,t,ii.lN itiriii. ilrff' 'EQ ii-rf QU! at view . ffl? Q27 -it .

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C YI! ' l .ul 1 l H' .1 1 l-N lvl lim 1 if la l l l il w lx ii lil W 155. lil lil liil '57, V wwf 3 V uf 4 li il will Hi keel - in i i i Hi Fi' PM H1 alll s 9 :fl ,425 .4?i'f'l E' E?-. , Vg.2ag,Qf',1?A LQ- lt gg. f 1 '- IL ff.-ilyfiii' in 1 ff4',..J l.lCHONilXli ? 'Fifi 1, ., we rfaiifu iiiita 1 we ' me ----WA 7 -- --.asf HENRY H. IVIORTON Cliniml Professor of Gcnito-Urizzary Diseases and Syphilis M.D., The Long Island College Hospital, 18823 Interne, St. Peters Hospital and New Haven Hospitalg Post Graduate Study at Prague. Munich, Vienna, Berlin, Paris. Member Committee on Venereal Diseases in oH'ice of Surgeon-General, U. S. A. Genito-Urinary Surgeon, L. I. C. H.g Consultant in Genito-Urinary Diseases, Kings County, Flushing, Sea View, Victory Memorial and Beth Israel CNewark, N. JJ Hospitals. Member of American Genito-Urinary Association and American Urological Association. Fellow American College of Surgeons, Fellow, New York Academy of Medicine: Member Kings County Medical Society. Author of -Genito-Urinary Diseases and Syphilis, 4-th Edition and numerous papers pub- lished in Journals. Page fifty-Iwo

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1251. -waz- I - -x rc f. rs--m N 'Mfg lsfffgxiing .sim ri El Haj, lt Qi I LJ ni wi R All 511 Ui r LL fi in S tll lilii itqgl' S2 lt l' ll! if lfjl 52 TEL! im, :id L i l d 'Q lfu 'lf 71 1 I' its N, li! , it 23 tl H? Vrll 1 .,. lj: lfilii .. E tell s.- ily: P-. isf was ,xii M lim L6 ,LJ ily' tang: gem, . ff-.'M'.ie ii,LZ15f.,-' ' -1-5-'if 1 -- . .-,,Y an it xg., r ' iii-f H P HCHUWMMW 75,5 title if. ll N21-4 . .-. f in. .,, 11.1. f ff:-,fi f .,:'.4, e i i, 12,-1 1 , 31:17-::?'?wf R' wfrses-.Q-.ss'qfT -1 at Jfiiairsi'-,eeQEf, - ssxii-as -E - fem Leafs-A are 51 flag BIN? afsgsiftdrgsgscssm .mimics .M gsis,1sstsis2.tm .K llama- 3. at - 1 -sa-, ,img Albert Neisser, of Breslau, in 1879 and 1882, discovered and described the gonococcus. His observations were confirmed by many other bacteriologists, and this organism was then accepted as the causative factor of gonorrhea. Confirmation of these views was further made in 188+ by Bumm, who made cultures of the gonococcus and inoculations. After the discovery of the exciting cause of the disease, in order to acquire a true knowledge of the disease, it still remained to study the changes in the tissues by means of the microscope caused by the invading organism. This was done by Bumm in the conjunctiva of infants suffering from gonorrheal ophthalmiag but it remained for Finger, of Vienna, to give to the world an exact knowledge of the changes in the tissues through actual microscopic examination of autopsy specimens from the urethra removed from patients suffering from acute and chronic gonorrhea and stricture. So much for the history of the disease. Let us now glance at the early forms of treatment. The earliest rational form of treatment was discovered by Aretaeus in the second century. He used astringents in the bladder, cooling substances in the loins, embroca- tions of oil of dill or aromatic white wine, and his hygienic regulations were similar to those in use at the present day, namely, sexual abstinence and prolonged cold baths. ln the ninth century Rhazes used injections into the urethra of honeyed water or decoctions of quince seeds, and finally healed the inflammation with antimony. The pain of urination was relieved by warm vinegar or rose water, containing opium, injected into the bladder. But all the early treatment was not as logical as that which has been described, for we hear of Guy de Chauliac recommending the use of the excreta of pigeons internally, and advising applications of the flea or louse to the meatus as being of great importance! The treatment as used by Ricord and other physicians here described was prac- tically followed out by all the profession until the discovery of the albuminates of silver twenty years ago gave us a drug which fills Neisser's indications for the treat- ment of gonorrhea. The indications for the cure of this disease, as set forth by Neisser, are: First. Destroy the gonococci in all foci within reach as early and completely as possible. Second. In doing so, avoid irritation of the mucous membrane, any exacerbation of the existing inflammation, and everything else which has a caustic action on the tissues, together with the avoidance of all unnecessary pain, or, in the words of the ancients: Cito, tute et jocundef' Perhaps the greatest advance of all which has been made since the time that Ricord settled the question of the duality of gonorrhea and syphilis, is the recognition of the great principle that gonorrhea is a self-limited disease, and that the suppuration is the effort of nature to remove the invading organisms by enclosing them in pus cells and throwing them off from the body. With this in mind, and the knowledge of the pathological changes in the tissues, we stand with open minds, ready to receive new facts which the progress of biology or chemistry may bring to our aid. VVhat lines the future treatment of gonorrhea may follow, by either destroying the invading organisms directly by chemicals, by increasing the body resistance through vaccines, by direct application of heat, or by some physical, biological or chemical force which is as yet undreamed of, no man can say. We can only wait and see what the future may bring forth. ' HENRY H. MoR'roN. Page fifiy-fum