Cancer scrod, or chimney-sweeper's cancer, commences in the scrotum with an ulcerated wart, or rugged ill-looking sore, with hard and elevated margin. It penetrates the scrotum, affects the testis, ascends along the chord, contaminates the inguinal glands, and terminates the patient's existence in a most deplorable way. Extirpation in the early state is the only effectual mode of treatment. Gonorrhea is the discharge of a mucous or purulent fluid from the urethra, occa sioned by the application of infectious matter from another subject labouring under the disorder, and generally corn. municated by coition. The urethra may be irritated so as to furnish a preternatural quantity of secretion by other causes ; as strictures, use of bougies, &c. It general ly comes on from six to twelve days after the infection ; and commences with an itching and fulness of the mouth of the urethra. A discharge follows, first of a watery and transparent kind, and then becoming thicker and white, yellow or greenish. The glands swell, and the membrane at the mouth of the urethra becomes smooth, red, and swollen. An acute scalding pain is experienced in making water, which is voided frequent ly, and in a diminished stream. Trouble some erections are experienced at night. Various sympathetic affections often at tend; as pain and soreness over the whole pelvis, in the scrotum, testicles, anus, &c.; enlargement of the inguinal glands, form ing sympathetic bubo, and irritability of the bladder. It has been much disputed, whether the matter of gonorrhea and chancre be the same, and consequently whether the constitution can be affected from a gonorrhoea. But at present most surgeons are inclined to support the ne gative side of the question ; and all act in the treatment of the complaint on this supposition.
In ordinary cases the affection does not seem to extend more than about two inches along the urethra. The complaint increases in violence for about three weeks, and then gradually declines ; a discharge often remaining when the other symptoms have entirely subsided, and be ing then termed a gleet. There is little power of stopping the course of the com plaint, at least without great risk of in ducing hernia humoralis; so that the sa fest plan is to palliate. Occasional saline purges, abstemious regimen, and copious draughts of diluting and mucilaginous li quors, are proper with this view. Sus pension of the testicles is useful as a pre caution against hernia humors/is. Cold applications to the penis. After a few days, astringent injections may be em ployed, often with the effect of lessening the duration of the discharge considera bly. Zinc. vitriol. gr. ijss. in two ounces of water ; or hydr. muriat. gr. j. in eight ounces of water, will do for the beginning; but their strength may be increased. Opi um and antimony, where the symptoms of irritation are very considerable ; balsam copaiva is also very useful.
The gleet which remains after a gonor rhea is not infectious, although very trou blesome. Astringent injections may be tried for it ; as hydr. mur. fir. ij. in sq. distillat. 3 viii or zincum vitriol or cupr. vitriol. in larger proportions. Balsam co paiva or tinct. cantharid. may be taken internally.
Chordee is an inflammation, attended with extravasation of coagulating lymph into the corpus spongiosum urethra, or corpora cavernosa penis, which renders the penis curved in its erect state. Bleed ing by leeches, fomentations and poulti. ces, with the antiphlogistic regimen ge nerally ; and afterwards camphorated mercurial ointment.
Sympathetic bubo should be treated as a case of common inflammation. Affection of the bladder may be combated by the warm bath, venesection, leeches, and fo mentations to the perineum and bladder, and opiate clysters Phymosis and Paraphymosis. In the former the prepuce is so contracted, that it cannot be withdrawn over the glans ; while in the latter it cannot be drawn for ward from behind the glans. The irrita tion of chancres, gonorrbcra, &c. is the common cause of these affections ; but some persons are born with a phymosis. Frequent injections under the prepuce are necessary in phymosis, which need not prevent the use of mercury if it is re quired. If the contraction be so great as to confine the matter, and absolutely pre vent its discharge, the prepuce may be slit open, but not otherwise, in the in flamed state. When the complaint has subsided, and the contraction still remains, the following op ration may be perform ed. The surgeo rasps the prepuce with a pair of harelip ioceps, leaving out as much of the outer fold as he wishes to remove, and cutting this away at one stroke of the knife. He then slits up the inner fold with a crooked bistoury pass ed in a director.
In paraphymosis the glans can general ly be returned by pressing the blood out of it, after immersion in cold water, and drawing forwards the prepuce. Leeches may be applied to the glans to diminish its bulk. If these means do not succeed, the stricture must be cut through.
Amputation of the penis is necessary in cancer of that organ ; hut it should be done before the glans are affected. One stroke of the knife is sufficient for the purpose, after which the bleeding vessels must be secured.
Strictures in the urethra are contrac tions of the canal; which may be either temporary, when they are called spasmo dic; or permanent, in which case there is a projecting ridge of the membrane, or a continued contraction, occupying some length of the canal. The latter are also subject to attacks of spasm from inflam mation, &c. ; and vary in their state under different circumstances. if there be only a single stricture, it will be generally found at the bulb of the urethra ; that is, about six and a half or seven inches from the mouth of the urethra; and where strictures are situated nearer to the end of the penis, there is almost always one in the former part. The symptoms of the complaint are, diminished stream of urine, which is voided more frequently than is natural, and with difficulty ; gleet, noc turnal emissions, impeded ejection of the seminal fluid in coition ; irritability of the bladder, which secretes a mucous fluid. Sometimes there is a complete paroxysm of fever; and occasionally swelling of the testicle. Strangury and total retention of urine are sometimes the consequence of a stricture, which becomes affected with spasm from some occasional cause.