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quote Lydston: "Stricture, the most important sequel of gonorrhea, is often productive of the most profound pathologic disturbance in the proximal portion of the genitourinary tract. Inflammation of the bladder, calculous disease, inflammation and dilatation of the ureters, surgical diseases of the kidneys, and possibly ordinary Bright's disease are often directly traceable to it. Few individuals who have suffered from pronounced stricture are unaffected either with renal disease, or what is practically the same thing, a locus minoris resistentiæ in the direction of the kidneys that favors the development of acute or chronic Bright's disease from apparently trivial causes. There are few, if any, cases of posterior gonorrhea in which the prostate is unaffected. It is the author's view that many individuals who, in after-life, develop prostatic hypertrophy owe that condition to the effects of an early gonorrhea. We are all aware of the frequency of prostatic affections in old men.
If these were the worst features and sequels of gonorrhea in the male, the state of affairs would be so much better than they really are. These gonorrheal sufferers marry nearly always before they are completely cured. Now, if gonorrhea in the female manifested its ravages as it does in the male, how much more fortunate for all concerned. The female urethra is rarely affected. The vaginal walls resist the gonococcus with almost unvarying success, but the endometrium falls an easy prey. When the germ has reached this citadel of safety from successful medication it holds out a defiance to the genito-urinary surgeon that makes him quake with disgustful awe.
Of gonorrhea in the female, Lydston has to say: "The more carefully we study pelvic diseases in women the narrower their etiologic field becomes, and the more frequently they are found to be dependent upon gonorrhea.
Thus, when freed from pathologic and anatomic errors pelvic inflammations are found to be dependent in the majority of cases, if not all, upon tubal diseases, and tubal disease is unquestionably almost always due to gonorrhea and its congeners or derivatives." I am quite sure that the most cases of "one child sterility" are not due to a lacerated cervix or perineum, but to the ravages of gonorrhea on the generative organs.
Now as to the frequency of gonorrhea in the female we find that Noeggerath said some years ago that he questioned the husband of every woman who came under treatment, and he was of the opinion that we could apply to the dictum of Ricord that eight hundred men in one thousand have had gonorrhea, and that he believed 90 per cent. of cases remained uncured, and that he believed of every one hundred women who have married men formerly affected by gonorrhea hardly 10 per cent. remained well; the others are affected by ailments consequent upon gonorrhea.
Here is a picture from life that is seen often by every practicing physician: A youth has harvested from his crop of wild oats just a case of gonorrhea. He is treated by a so-called genito-urinary surgeon. He is unwarned of the breakers ahead, and he leads to the hymeneal altar a fair young bride. She is the idol of her home, as innocent of evil as when an infant on the mother's breast. Often in a few short days of bliss the fire of gonorrhea begins to consume her on this altar; even before she conceives. Its ravages are so complete that she can never be a mother, and she drags out a miserable existence. She consults the most eminent specialist and all the available means are expended in quest of health, but none can be found. The dear relatives question the "wise dispensation of Providence" in so afflicting one so pure and inno
cent. As she expresses it, "she rarely has an easy moment." How different if the husband had been forearmed Ly being forewarned and cured.
Would that this resolution could be assimilated into the moral nature of every physician on whose ears these words fall, and unto whom these lines may come. Í shall henceforth use extreme diligence to inform all cases of gonorrheal patients of the gravity of the disease, and shall strive to engender into the public mind a complete abhorrence and perfect disgust for the disease.
BY J. H. CRAWFORD, M.D., MARTIN.
This is a subject in which I have long been interested. It is one to which I have given close attention since my graduation in 1900. To the profession it is in my mind of paramount importance, and it is one which should receive attention from every physician and surgeon in the country.
Of course, I do not claim to know everything there is to know with reference to circumcision, but I have seen so many bad results from the neglect thereof that I have attempted to write a paper upon the subject, and try to call the attention of the profession to the importance of early circumcision in cases where it is needed.
This subject seems to be neglected in some degree by the profession, for I have heard few papers read at our regular meetings with regard to circumcision or kindred subjects.
Now, if I do no more in this paper than to merely call attention to the importance of same, then I shall have accomplished something, and my paper will not have been written in vain.
In the first place, what is circumcision? It is derived from two Latin words, viz.: Circum, meaning round, and caedo, to cut, and literally means to cut round. It means the taking away of the foreskin, or prepuce, as an operation in minor surgery.
We shall first consider the diseases, or rather the malformations of the penis, which demand surgical attention, circumcision or retraction of the foreskin or prepuce.
Now, the malformations of the penis which demand our attention in this connection are only five, viz.: Adherent prepuce, phimosis, paraphimosis, hypospadias and epispadias, the most important malformations being the two former.
Adherent prepuce: We sometimes hear this condition termed false phimosis. You will find this condition in almost all male children, and its occurrence is so very frequent that we can hardly call it a malformation. In every male infant, however, where this condition of adherent prepuce is found it should require immediate attention.
In cases where it is unnecessary to circumcise, when the prepuce is not too long, it is only necessary to retract forcibly the foreskin to completely bring the glans into view, then to remove the smegma by wiping or washing it away and cover the glans penis with a few drops of oil or sterile vaseline and then draw the skin forward over the glans. This should be repeated every day until the patient is well. Don't leave this for members of the family to do, for they will not properly attend to it. It is a delicate operation and one which causes considerable pain to the little fellow and if left to the family it will in a few days be in the same condition as before the operation.
Phimosis: This is a true malformation of the penis and it may or may not be congenital. In phimosis it is impossible to retract the prepuce over the glans. It is usually congenital, but it may be brought about by inflammation. In congenital phimosis there is retention of sebaceous matter or smegma. This in itself will start up inflammation, and you will have then adhesion of the foreskin to glans.
This form of phimosis may induce irritability of the bladder, incontinence of the urine, prolapse of the rectum