The Secrets of Specialists/Chapter 25

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The diseases resulting from the "great social evil" have always contributed liberally to the physician's yearly income, as it may be conservatively stated that one-tenth of the physician's income, comes from this source; therefore, placing the average physician's income at $1,000.00 per year, there would be paid $14,500,000 for medical fees in America, for the treatment of Genito-urinary and venereal diseases. This is such a profitable branch of medicine that the advertising physicians have nearly abandoned other diseases, stating that they can receive larger fees, with less labor, than are obtained in any other specialty. It is this reason that makes this specialty so conducive to "quackery," The medical and minor surgical therapeutic procedures have been greatly improved in Genito-Urinary and venereal diseases, within the last few years. We will, therefore, outline many of the modern methods of treatment used in these special discases.

The most prevalent of venereal diseases has been described, from time to time, under the synonymous terms blenorrhagia, gonorrhoea, clap and urethritis. This disease, for a very long period, was a fruitful theme of debate, to identify this condition from syphilis. The history of this disease will date back to the origin of the first unclean woman, and that means the origin of the species; therefore, Rudyard Kipling need offer no apology for writing "the female of the species is more deadly than the male." Moses, in his wisdom, was the first to recognize and institute prophylactic measures to prevent this, and ​other venereal diseases; and in his code of moral laws the males were not only required to be circumcised, as it was thought the prepuce was responsible for spreading disease, but the females were required to be separated from their husbands during the menstrual and other periods. These are the first prophylactic measures which history has given us. The vagina offers a most prolific field for the generation of germs, containing pathogenic properties; its exclusion from light, and the decomposition of the secretions from her own generative organs; together with the physiologic secretions from the male, the semen, and the irritation during cœtus makes it a particularly favorable seat for decomposition, and the development of irritating toxins.

The treatment of gonorrhœa consists of both internal and local measures. The internal medication may cover a large number of remedies, but the true specifics are few in number. The principal effects desired is to relieve the pain during the acute stages, and render the urine alkaline. The following, in tablet form, will be found very serviceable:

Ext. Kava-Kava	1	gr.
Potass. Bicarbonate	2	gr.
Oil Sandal	1	gr.
Oil Cubeb	½	gr.
Balsam Copaiba	½	gr.
Iron Sulphate	½	gr.
Salol	1	gr.
Pepsin Pure	½	gr.

Two tablets three or four times daily.

The local treatment is of the greatest importance, and I always prefer these medications in the form of urethral bougies, as it is more accurate, convenient and thorough than other forms of local medication. These treatments are supplied in the form of long, narrow pencils, which are used with an applicator, (as is illustrated here), or each bougie is wrapped in paraffin paper coil, or tube, which answers the purpose of an applicator, and also protects the bougies from melting ​when not in use. This is the best means of reaching all areas of the urethral tract, and has the advantage in prolonging the medication to any discased area.

The following formula in bougie form is as near a specific for urethritis as can be obtained by medicine:

Protargol	¼	gr.
Hexamethylenamine	¼	gr.
Quinine and Urea hydrochloride	1-6	gr.

Sig.—Use a bougie three or four times a day, and before retiring. Always instruct your patient to urinate before each application, as this clears the canal of toxic secretions.

In resuming the above formula, we have the combined astringent and antiseptic effects of Protargol, which has long been recognized as superior to other astringents, or germicides, in the treatment of this disease; this is reinforced with Hexamethylenamine, whose relation to formaldehyde makes it a most favorable treatment for the destruction of micro-organisms. Quinine and urea hydrochloride is not only a mild astringent, but also an anodyne and prolonged anæsthetic. The addition of this remedy is indispensable in treating this disease, as its obtunding properties immediately stop all pain and irritation, while the other medications are effecting their permanent results. In fact many patients will state they would not know they were diseased if it were not for the discharge.

Stricture is a narrowing of the urethral canal from any cause, and may be spasmodic, congestive, inflammatory or fibrous. This is one of the most frequent complications of gonorrhœa, and although the different forms cannot always ​be differentiated clinically, it becomes the physician's duty to institute a means whereby the canal will maintain its normal caliber. For this purpose, there have been many different treatments used, from time to time. Space will not allow a discussion of all these methods; we will, therefore, confine our treatment to the more simple and practical measures.

A large percentage of strictures following gonorrhœa are the results of forming fibrous tissue, due to the inflammatory process narrowing the canal; thus the treatment is directed to dilate or stretch the canal to its normal caliber, or absorb the fibrous tissue by electricity or medicated bougies. The gravity of stricture will depend upon its distance from the meatus; the nearer this orifice the more easily cured, and the farther the distance the more difficult to master. Forced dilation does not offer us a successful treatment, except in the most superficial

constrictions. When the stricture is deep seated, they may be made to admit a large sized sound, and we congratulate ourselves that we have relieved the constriction only to be disappointed by the patient returning in a few days with no apparent improvement. It has been demonstrated, however, that thiosinamine applied in bougies, after dilation, would produce permanent results. The technique of the operation is as follows: locate the seat of the constriction, and dilate the stricture with graduated sounds as far as possible, and, after withdrawing the sound, insert a bougie composed of the following:

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Thiosinamine	½	gr.
Resorcin	¼	gr.
S. E. Thuja	¼	gr.

A few of these dilatations and medications will usually overcome the most obstinate cases of urethral constriction due to fibrous tissue. Thiosinamine may also be used by cataphoric application as follows: the cataphoric urethral electrode (shown on page 275), is saturated with the thiosinamine solution, as for treating scar tissue. This is inserted to the constricted area, on the positive pole. The negative pole placed on the abdomen, and five milliamperes of current used for five minutes. A very few of these treatments will be followed by the most excellent results.

The frequency in which varicocele occurs, in the adult male, has offered a field for an independent specialty, and nearly every city contains a "Varicocele Specialist," who, as a rule, charges the uniform price of $100.00 for treating this disease. The injurious effects depicted by these specialists, are greatly exaggerated, however, with a view of depleting the purses, by frightening the victims with the statement that this disease will result in impotency, while the truth remains that this disease is not a serious condition, and produces comparatively little discomfort.

Surgeons differ greatly in estimating the frequency in which this disease occurs. Dr. Henry, police surgeon of New York, found 41 cases in 2,000 robust and healthy men, examined for police service. Ludston gives an estimate of 5 per cent. in men examined for military service, which would give a better percentage for average healthy men. At any rate, varicose veins are more frequently found in the plexis of veins surrounding the spermatic cord than in any other part of the body, and often require treatment to cure this condition, even if the disease is not dangerous. It relieves the annoyance, portrayed by bold advertising, upon the minds of many neu​rotic patients, and prevents them from falling into the clutches of quacks, who point at this condition as a consequence of noctural emissions, masturbation, and resulting in "physical decay" or impotency.

There have been many operations devised for the relief of this condition; the two which have been the most universally

successful are the open ligation, and the subcutaneous ligation. I prefer the former, as you are not required to work in the dark. The open ligation method is a very simple operation, and you have the minute anatomy constantly under your observation, and avoid any possibility of including in your ligature tissue which is not required, and often leaves unfavorable results by not completely strangulating the veins. ​

The field of operation is made surgically clean by shaving, and bathing the parts with a bichloride solution, and a local anæsthetic injected into the parts to obtund the pain; a small incision is made, high up as possible, the varicose veins located, and tied with chromicized catgut, being careful not to include the vas deferens or other tissues; the wound is now closed, under antiseptic precautions, and sealed with collodion. In the subcutaneous operations the same results are attempted, but it is almost impossible to isolate the veins and ligate them without including other tissue, even in the most skilled hands. The technique of the operation is as follows:

After observing surgical cleanliness, and the use of a local anæsthetic, if necessary, (this is seldom required, however, in this operation), the Whitehead or Riverdine needle, threaded with an antiseptic ligature, is made to transfix the scrotum at a distance of the junction of the upper middle third of the distance from the inguinal ring to the testis; after the needle has passed through the scrotum the vas deferens should be located internally, and separated from the veins. The needle is now transversed to the point of first entry, and if the operation is successful, the two ends of the ligature tied, which includes the mass of veins producing strangulation. The point of puncture should be sealed with collodion.

Hydrocele consists of an accumulation of serous fluid, in the tunica vaginalis testis caused by continuous irritation. This is found in ten per cent, of the male population in Brazil and other tropical climates where the scrotum being relaxed and pendulous is more liable to injury. Wearing trousers tight in the crotch has also been given as the cause of injury. While there are several methods advocated to permanently cure this condition the injection treatment, in its different forms, is in the greatest favor. There have been many remedies advocated ​for this purpose, among which may be mentioned all the astringents, sulphate of zinc, alum and vegetable astringents depending upon tannin; tincture of iodine and carbolic acid are also general favorites. The former is the most universally used, but the latter has been demonstrated to be of the greatest value, and owing to its anæsthetic properties renders the operation nearly painless. I prefer the tincture of thuja, however, to any of the injection remedies.

Many newly formed hydroceles are permanently cured by only withdrawing the fluid, and in reviewing this history, I only use this means for the first operation, but if the sac is refilled, or in old chronic cases, the injection treatment should be used. The technique of the operation is as follows:

The tumor is held in position with the left hand, while the right hand forces a trocar well into the sac, see illustration, ​avoiding the testicle; the trocar knife is now removed, and the fluid withdrawn, with the metal cone of the trocar still inserted in the sac. A long, blunt pointed needle is inserted through the metal cone, through which is injected the following solution into the sac:

Thuja (Lloyd's specific)	½	oz.
Glycerine	1 and ½	oz.

This should be manipulated rather vigorously until the entire surface has been thoroughly covered, and the solution is allowed to escape, and the site of puncture sealed with collodion. This is, as a rule, a very successful operation, and I prefer thuja to carbolic acid or iodine, and other astringents and caustic remedies, as we obtain an equal degree of success with less heroic measures. The patient should wear a suspensory bandage for a few days, and in old and feeble patients it is best that they should remain in bed for a few days until the reaction thoroughly subsides.

Spermatorrhœa, nocturnal emissions and impotency are the three conditions of the male sexual system which have offered the advertising physicians of the past the most profitable field for their operations, to commercialize medicine, by both local advertising and in the mail order business; owing to their bold advertising in the yellow press, the regular physicians have, apparently, neglected these conditions, fearing, perhaps, if they would give them due consideration, they would be associated with the bold faced quack, but inasmuch as many state and national laws have stopped their operations, the general practitioner may now consider this a legitimate field. Through the cleverly worded advertisements of the charlatans, the laity have been taught that nocturnal emissions and spermatorrhœa are of the same condition; although spermatorrhœa has been defined as an involuntary loss of semen, independent of intercourse, it does not necessarily involve nocturnal emissions. True spermatorrhœa is caused from a weakness of the ​seminal ducts, while nocturnal emissions are a physiological phenomenon, characteristic of the vigor of youth. By painting, in these young minds, the picture of lost vitality, "weak manhood" and "general debility," which will terminate in placing the victims behind prison bars, and in mad houses, has constituted the blackest sheet in medical advertising; on the other hand the secretions which escape while straining at stool, and during sexual excitement from the prostate and Cowper's gland have also been used in their argument to frighten their patients. What is there in the practice of medicine more condemnable than to attempt to create disease for the purpose of curing it for personal gain?

The above outlines the conditions described by some writers as pseudo spermatorrhœa. The fact remains that true spermatorrhœa is not of very frequent occurrence, but when it does appear, is the result of sexual excesses, masturbation or perhaps excessive nocturnal emissions, or a combination of all three causes, resulting in a weakness of the organs, whereby diurnal or nocturnal emissions take place without sensation or power.

The treatment of spermatorrhœa may include moral, psychic, medical and mechanical measures. The patient should ​be advised that nocturnal emissions, in the young and vigorous, is not of a serious consequence, as is portrayed by the quack, and unless this condition is at too frequent intervals will not terminate in serious results.

Masturbation is the most frequent cause, however, and although the patient will usually deny this practice, he should be emphatically advised to abandon the habit. Nocturnal emissions may often be relieved by sedatives, but the most positive way of mastering this condition is with the so-called "Spermatorrhœa ring," illustrated here; although this instrument is a product of an advertising physician, who in the past has reaped a fortune from its sale, it is now extensively used by many physicians. The ring is placed around the penis, while in a flaccid state, at its base on retiring, and if an erection takes place during the night it will expand and prick the organ, thus awakening the patient, who should be advised to urinate at this period before going asleep again; with the use of this instrument, and moral advice, we have at our command the only radical cure, as far as relieving the cause is concerned, but where these cases present themselves at a late hour, we have a different condition to deal with—Impotency.

Impotency has been described, by most writers, as existing in two forms, viz.: pseudo-impotency and true impotency. In the former there seems to exist, in certain individuals, a lack of confidence in themselves, or they may be impotent with blondes, and not with brunettes, and vice-versa; in others, the erection may be weak, with premature ejaculation. These are often due to conditions of the mind. He remembers the advertising literature of the quack, and comes to the conclusion that he is physically weak. It is this condition that the family physician has neglected and treated lightly, and the charlatan has magnified the evil consequences for large professional fees The only treatment required for many of these cases is suggestive therapeutics, and relieving their minds of any impend ​ing danger. Do not laugh at his imaginary troubles, and actually drive him into the hands of the quack with your ridicule, but treat him with all the seriousness of a more grave condition. There are many ways of stimulating the sexual organs, whereby profound and prolonged erections may be maintained; the passing of a cold sound twice a week, or an application of the electric current, may produce the desired results. Premature ejaculations may be due to an excessively sensitive gland penis, as a consequence of a phymosed prepuce and circumcision will effect a cure, while much can be done in false or nervous impotency by establishing a feeling of self-confidence in the patient. True impotency due to an exhausted condition of the sexual apparatus and nervous system from excesses, will require more heroic measures.

Many remedies under the classification of aphrodisiacs have appeared from time to time, and although excellent results have been obtained from many of these, there are few specifics; the following, however, in tablet form, offers the best combination of medicinal agents I believe in present use. It has reached at least a sufficient degree of perfection to be referred to by many physicians as the "pill that will." The formula is as follows:

S. Ext. Galega	3	gr.
Chromium sulphate	2	gr.
Zinc phosphide	1/10	gr.
Ext. Nux Vomica	¼	gr.
Cannabin	1/10	gr.
Cantharides	1/12	gr.
Avenine	1/200	gr.

Sig.—A pill six times a day.

In resuming the therapeutic value of the above formula I believe Galega to be the most specific remedy we have for the treatment of impotency for either sex. It is a glandular stimulant and, apparently has a select action upon the sexual organs of both sexes (see page 351).

In conjunction with the above tablet, I frequently pre​scribe the fluid extract of Galega in one-half dram doses, to stimulate the secreting glands of the sexual system, and I have often been surprised at the new life it establishes in dormant or worn-out sexual systems, in both sexes. This remedy is reinforced with Chromium sulphate, Phosphide of zinc and nux vomica; each bearing their tonic and stimulating influence to the nervous system. Cantharides may be called the true sexual excitant in small doses, which is likewise reinforced with the alkaloids, Avenine and Cannabin.

This tablet has a wide range of usefulness, and although it has achieved the name "the pill that will," through its

success in treating impotency, it is of equal service in many other conditions, where a nerve tonic is required. It is one of the best medications for the tremor of alcoholism, and to build up the system after debauch, spinal and cerebral anemia, locomotor ataxia, and many other nervous diseases, are also successfully treated with this medication.

Vibratory massage with the ball vibratode from the tenth dorsal to the coccyx, using the medium speed and long stroke, occupying from six to eight seconds, at each center, is of much more value in functional impotency. Electricity to the same area, with the brush applicator to the penis, has been success ​fully used in many cases. There has been rather elaborate cupping apparatus devised for the purpose of exciting the sexual system by increasing the blood supply, by the Bier method. A far better and more successful treatment, however, is to ligate the two superficial dorsal veins of the penis, (veins dorsalis penis superficialis); this is a very simple operation, and involves just sufficient technique to be called a "surgical operation," and is therefore used to a good advantage in extracting large fees by the irregular physician. The technique of the operation is symplicity itself. The parts are made surgically clean and anæsthetized with cocaine; pick up the veins with the thumb and finger, and pass a small curved needle through the integument, and under the vein near the base of the penis. The needle is now transversed, entering at the exit, and passed above the vein to the point where it first entered, and ligated, and the two openings scaled with collodion. Both veins should be treated in this way. The object is to obliterate the veins, and cause congestion of the organ, the reaction of which will produce the necessary erection. Some prefer the open operation as is illustrated here, as you have your work constantly before you as in the varicocele operation. This operation, and the use of the "pill that will," will restore this function, in a large majority of cases, and many physicians have the courage to charge a fee of $100 for this procedure, and the patients seem to believe they have received their money's worth, and thus their prayers are answered:

From the age of forty to the decline of life enlargement of the prostate gland is of such frequent occurrence that it is often looked upon as a natural consequence, rather than a ​disease, and if our Creator has selected any one organ of the male sexual system to equalize or correspond to the suffering endured by women for the pro-creation of the race, he has concentrated his efforts in this gland, which is often referred to as analogous to the uterus of the female. This over-growth of tissue is not only a constant menace during advanced years, but it often robs the patient of many years of his life, unless therapeutic measures are instituted for its relief or cure.

These patients will generally consult the physician under the erroneous idea that their kidneys or bladder is diseased. They will complain of difficulty in starting the urine; although there is a frequent desire to urinate, especially at night. Will also state that the stream and force is diminished, even to dribbling, and the bladder is unrelieved by his efforts. These symptoms, together with neuralgia pains in the penis and testicle, with a sensation of weight in pelvis, and a discharge of glairy mucous will reveal to you an enlarged prostate. To confirm the diagnosis, however, a digital examination is made through the rectum, and the patient is requested to pass his urine in your presence to observe the force and volume of the stream.

The treatment of enlarged prostate will naturally be divided into palliative measures, for the immediate comfort of the patient and those directed to produce permanent results. Hyperacidity of the urine, and irritation at the neck of the bladder may be relieved by Triticum, Repens, Pichi, Oil of Sandalwood, Buchu and other similar treatments. Hexamethylenamine, which is also sold at fancy prices, under the coined name of "Cystegen," is one of the best remedies, especially where there is decomposition of urine. With this remedy we receive all the benefits from formaldehyde in a convenient form to dispense.

In advanced cases the residual urine should be withdrawn, and the bladder washed occasionally to prevent decomposition. The passing of sounds will often afford temporary relief, by increasing the force and caliber of the stream.

​Of the internal remedies, which have been given with a view of producing permanent results, Ergot, Saw, Palmetto and Galega perhaps are in the greatest favor. These, administered in combination, in the following formula, will produce better results than any medication to my knowledge:

F. E. Ergot	1	oz.
F. E. Saw Palmetto	1	oz.
F. E. Galega	2	oz.
Simple Elixir, q. s.	6	oz.

Sig.—A teaspoonful three or four times a day.

Although Ergot and Saw Palmetto have long been looked upon as favorite remedies for enlarged prostate, reinforcing these drugs with Galega is of a decided advantage, as this remedy has a remarkable influence in stimulating glandular tissue.

The trend of modern therapeutics has a tendency, however, to favor local medication, in the form of suppositories, applied through the rectum to the prostatic area; and also the cataphoric application of drugs. A suppository which has rendered me much service is as follows:

Thiosinamine	4	gr.
S. E. Saw Palmetto	4	gr.
S. E. Galega	1	gr.
Cocoa-butter, q.s.	24	gr.

Apply through the rectum to the prostatic area before retiring.

The thiosinamine solution used to remove scar tissue, as advocated by Dr. Nieswanger, is also one of the most successful means of treatment at our disposal. These methods used independently, or in combination, will give relief, and apparently cure a large number of these obstinate cases.

In order that I may outline the method of using the combined treatment, I will cite the following case:

Mr. H., aged 64, merchant, from subjective symptoms and digital examination, presented a typical case of prostatic hypertrophy, with most of the symptoms previously described, ​and was obliged to urinate several times during the night; he was directed to take a teaspoonful of the Galega compound, three times a day and a prostatic suppository was applied each night before retiring.

Every four days the patient visited the office for the cataphoric application of thiosinamine; the technique of its application was nearly the same as advocated by Dr. Nieswanger. An electrode (shown in Fig 1, page ), was used, by using an applicator of galvanized iron, instead of copper wire. This applicator was loosely wound with absorbant cotton for about two and one-half inches, and saturated with the same thiosinamine solution, as is used for removing scar tissue, on page (illegible text). The wire applicator is slipped into the hard rubber protective shield of the applicator. This was well lubricated, and passed to the prostatic area of the urethra, attached to the positive pole; the negative pole applied to the abdomen with the pad electrode. The continuous current was gradually turned on, until it reached ten milliamperes, and the current allowed to flow from eight to ten minutes.

At the end of two weeks the patient would not be disturbed in his sleep, by the desire to urinate in the night, and in less than two months was discharged as cured.

This form of inflammation of the bladder, frequently succeeds the acute disease and continues as a low inflammatory catarrhal process; taking on acute symptoms at times and again lapsing into the sub-acute state. This is especially so when accompanied with enlarged prostate. The following formula has been of much service to me:

Hexamethylenamine	2 gr.
Ext. Corn Silk	1 gr.
Ext. Pichi	1 gr.
Ext. Buchu	1 gr.
Ext. Hydrangea	1 gr.
Atropine Sulph.	1.600 gr.

​Dose: A tablet every three hours followed by a large glass of water.

This simple electric prescription has also given me excellent results:

Cannabis Indica (Lloyds)	1	dr.
Collinsonia	2	dr.
Gelsemium	½	dr.
Aqua, q.s.	4	oz.

Sig.—Teaspoonful every hour for 12 hours then teaspoonful every four hours.

My attention was first called to the medical treatment of this disease by an article written by Dr. J. Marion Sims, which contained many astonishing assertions, and, after using this vegetable alternative, in my practice in many cases, I am convinced that the prescription he gave might almost be called a specific, if such a thing were possible in the treatment of the disease. Although many physicians are familiar with this prescription, I think it will be of sufficient interest to give you a history of it which dates back from its discovery among the great medicine men of the Creek Indians, who in early times inhabited middle Georgia. The negroes in that vicinity finally adopted the preparation and prepared it as given to them by the Indians. Dr. Sims' article would be too long to insert here, but Dr. B. Rush Jones, brother-in-law of Dr. Sims, gives the following:

"A few years before the civil war there were many obstinate cases of secondary syphilis around Montgomery, which had resisted the efforts of the best physicians. They went the round of the doctors, and could not be cured. One of these was advised to consult an obscure negro, by the name of Lawson, who worked on a cotton plantation, and after being under his treatment for a few weeks was perfectly cured. His recovery was so great an event that others applied to this same Lawson and were also cured.

​Dr. G. W. McDade, hearing of these cases, took a great interest in the subject, and visited Lawson and obtained from him the formula used so successfully. It seems that this formula had come down from a mulatto slave, by the name of Horace King, who resided among the Creek Indians for several years before they removed west of the Mississippi river (1837) and had learned while with them their method of treating syphilis.

Dr. McDade says that instead of adopting the so-called Indian remedy as he found it, he began by eliminating those roots and herbs and inert substances which he knew were absolutely of no value. He selected the few known to possess medicinal properties, and instead of making a decoction, as had been done before, and which had to be made in large quantities every day or two, he had them prepared in the form of fluid extracts, which placed the remedy on a specific basis and insured uniformity of action. He then gives the formula as follows:

Fluid ext. of smilax sarsaparilla	16	parts.
Fluid ext. of stillingia sylvatica	16	parts
Fluid ext. of lappa minor	16	parts
Fluid ext. of phytolacca decandra	16	parts
Tine. of xanthoxylum carolinianium	8	parts

Dr. Sims in his article gives many cases which were treated by the negro Lawson on the plantation; he also mentions the success Dr. McDade has had with it. Dr. B. Rush Jones of Montgomery, who has been treating syphilis for more than 40 years, now says he has but little dread of undertaking the worst case since adopting this formula. He has repudiated mercury and idodide of potash entirely, as he says they are unnecessary when this formula is used.

From the odor and general properties of this combination we are led to believe it identical in formula with the much advertised and secret preparation called S. S. S. The printed matter on this latter preparation, which states that it has been in domestic practice in certain parts of middle Georgia ever since the retirement of the Creek Indians in that section of the state, does much to strengthen our belief.