DEPARTMENT OF PRACTICAL CASE MANAGEMENT


The period of incubation in gonorrhoea is from a little more than 48 to 72 hours or longer. In the male the disease first attacks the anterior urethra which is very susceptible to the infection and “weak in spontaneous curative reaction.” Therefore, in the lower urogenital tract conditions are favorable for the long retention of small foci of infection.


GONORRHOEA.

The three most serious and devastating communicable diseases having both acute and chronic as well as local and constitutional aspects are, in the order of their frequency, gonorrhoea, syphilis and tuberculosis.

Recent surveys show that syphilis is considerably more prevalent than tuberculosis and that incidence of gonorrhoea (U. S. Naval Service) 3.54 times that of syphilis. Some authorities estimate the frequency of gonorrhoea to be as much as nine times that of syphilis. The number of new cases of Neisserian infection in the United States amounts to several million annually and under present conditions the morbidity rate is certain to continue its upward trend.

We read and hear much about campaigns for the control of venereal disease and the great advance in our scientific knowledge concerning gonorrhoea, nevertheless, confusion regarding it still exists even among those who specialize in diseases of the urogenital tract. Moreover, according to a recognized authority “at least 90 percent of those afflicted are treated by those who have a very meager knowledge of the scientific facts of the disease and of the precise (italics ours) methods of its most effective treatment.” Of course this statement merely registers a regret that only about 10 percent of the afflicted placed themselves in the care of those who limit their practice to this field.

Homoeopathic physicians will be consulted by their share of the derelict 90 percent, for these are lost souls as far as the specialists are concerned.

Naturally for purposes of prescribing, we will treat the patient and not the nosologic entity gonorrhoea, However, we have much to gain by keeping ourselves informed and conversant with the latest facts and theories concerning this ubiquitous and currently well advertised “social disease.” The following material should be of practical value as well as of interest to the many homoeopathic physicians who are called upon to treat these cases.

The period of incubation in gonorrhoea is from a little more than 48 to 72 hours or longer. In the male the disease first attacks the anterior urethra which is very susceptible to the infection and “weak in spontaneous curative reaction.” Therefore, in the lower urogenital tract conditions are favorable for the long retention of small foci of infection.

With conservative case management and full “cooperation on the part of the patient, the disease should not spread by direct extension to the posterior urethra which is protected by a strong sphincter, or to the bladder which is protected by a second, although weaker, sphincter.

Instrumentation, the use of irritating chemicals or the injection of too much fluid (more than 6 c.c.) into the anterior urethra, or the injection of fluid under pressure may force the infection into the posterior urethra. If this becomes invaded the prostate will also become involved. The posterior urethra is closed except at urination by the two sphincter muscles and is therefore drained intermittently. The anterior urethra, on the other hand, is capable of draining purulent material continuously.

The bladder is very resistant to gonorrhoeal infection although non-venereal types of cystitis are fairly frequent. The ureter and pelvis of the kidney are also resistant and therefore seldom attacked. The testicle is almost never involved and the term gonorrhoeal orchitis is becoming obsolete.

Many lymph channels from the lower genital tract drain into the inguinal glands. These may become inflamed during the acute stage and cause considerable discomfort. Locally these gonorrhoeal buboes are no problem and require no treatment although they should warn the physician that the disease is on its way into the depths of the constitution.

In the male there are several para-urethral ducts of almost microscopic size.

These drain externally close to the external urinary meatus. These structures retain infectious material long after the acute symptoms have subsided and the female may thus become infected even without ejaculation on the part of the male.

The problem of prophylaxis in gonorrhoea may be reduced to any of three simple propositions:

1. Avoidance of all sex contacts.

2. Absolute fidelity between two sex partners neither of who was ever infected.

3. Use of a condom or cover with suitable care and cleanliness in its employment.

All other forms of prophylaxis are questionable as to their value. Chemical prophylaxis in particular we will mention only to condemn.

The highest grade of homoeopathic practice employs no local applications, injections, irrigations, salves or lotions of any kind, either from a prophylactic or a therapeutic standpoint.

Two important facts tend to limit the spread of gonorrhoea by means other than sex contact:

1. Gonorrhoeal pus lose its infective power soon after drying.

2. Thorough washing with soapy water eliminates practically all danger of spreading the disease by ordinary household or social contacts. Were it not for these two fortunate circumstances the disease would be far more of a menace than it is and it would attack indiscriminately both the righteous and the wicked.

In the treatment of acute gonorrhoea specialists stress the importance of full patient cooperation under penalty of the most dire complications and consequences. The favorable progress of the average case is seriously hindered by:

1. Alcoholic indulgence.

2. Sexual excitement.

3. Over exertion.

The least alcohol, even beer and light wines, are to be strictly avoided. The avoidance of the least thing that even slightly stimulates the sexual appetite must be avoided. Any physical exertion that is in excess of ones usual activity must be avoided. Long automobile rides even if customary are often detrimental and must be curtailed during the acute or florid state of the disease. Very severe cases and those made constitutionally ill will do better if put to bed and confined there until the symptoms subside.

Women must be especially careful during the menstrual period and many of them will do much better if kept at absolute rest in bed. Spread of the disease through the female genital tract is much less likely if motion is strictly limited.

According to present day authorities on the treatment of gonorrhoea, patient cooperation as outlined above takes precedence over any form of therapy that may be employed. The homoeopathic physician would do well to ponder this thoroughly and govern himself accordingly. He has the best and the safest weapons in the world with which to fight this disease but his best efforts may easily be set at nought by failure on his part to insist upon full cooperation in the matter of alcohol, sex and physical exertion.

Given an even break in the matter of practical case management, homoeopathy will easily carry off the laurels in the successful and really curative treatment of this disease.

Eugene Underhill