The accurate and systematic observation of the urine affords one of the most reliable means of information in regard to the favorable or discouraging progress of the case, but the processes are far too technical in character for the layman to grasp. Suffice it to say that by an intelligent and careful daily examination of the urine the well equipped physician can conclude as to the progress of the case, even without questioning the patient in regard to his feelings and sensations. Unfortunately relapses in gonorrhoea are very common, and clap threads and pus cells are often present in the urine for months and years, during a of which time the patient is, in very truth, a poisonous animal and exceedingly dangerous to any one with whom ne may cohabit.
"It cannot be repeated too often: clap is a dangerous disease! Aside from the many complications and consequences which it may bring to the persons affected, it can make the patient hopelessly blind in twenty four hours. These facts alone, among a multitude of others equally alarming, which affect the patient's self love, being duly impressed upon his mind, we may go a step farther. A disppearance of all external evidence of the disease by no means makes the ex patient unable to cause his wife's death. Lurking in the crypts, follicles and glands of his urethra may be gonococci. In the sexual relation these murderous bacteria are wholly or partially emptied out. Enough of them may be projected to pass with the semen to the regions where a future human being should be given life, and the prospective mother then has within her the fungus of destruction".
The average physician tells the patient that he is cured and allows him to pass out of his care far too early; and the great majority of patients, weary of the expense and eager to believe themselves free from a filthy disease, assume the responsibility of defining when they are cured by the assertion that it is all over when there is no discharge visible at the meatus.
The use of internal remedies alone, such as are prescribed by many physicians and druggists, is not in any event adequate to cure gonorrhoea; with these must be combined irrigations and applications to the diseased areas.
Acute Posterior Urethritis. In a typical case of uncomplicated gonorrhoea the disease is confined to the anterior part of the urethra, but in eighty to ninety per cent of cases the inflammatory process invades the posterior urethra, and forms an ominous complication.
"It follows, therefore, that the opinion heretofore entertained, that gonorrhoea, as a rule, limits itself to the anterior urethra, localizing itself chiefly at the bulbous portion, is wholly incorrect, since the reverse is true namely, that, as a rule, the infection spreads in between eighty and ninety per cent of cases through the entire length of the urethra, and only exceptionally in a minimum of cases is limited to the anterior urethra".
The symptoms are not usually noticeable when the disease spreads backward to the deeper portion of the urethra, and it is important to remember that this posterior urethritis causes the discharge from the anterior urethra to cease, thus misleading the careless physician, or druggist, or patient into the momentous error of supposing that a cure has been effected.
The blame for this attaches partly to the patient and partly to the physician; the former will not heed advice, will not rest, and will often continue in the indulgence of his sexual passions; and it is the plain truth that a large number of the latter treat clap in a routine and harmful way. In the typical case heretofore described, the reader will remember that improvement sets in after the third week, or acme of the process; but this is a critical time and a change for the worse, with ominous symptoms, may occur.
Recovery is then very slow and the conditions are favorable for the development of stricture, epididymitis, inflammation of the testicles, bladder, seminal vesicles and prostate gland. In posterior urethritis there is a profuse suppuration going on without the patient's knowledge; for the pus does not pour out of the end of the urethra as it does in anterior urethritis, but flows backward into the bladder. In this condition the patient will probably suffer with a burning pain between the testicles and in the peri nseum, and will have a frequent and intense desire to urinate tenesmus without being able to void his urine. Sometimes there is such a high degree of congestion of the urethra that blood is mingled with the urine.