Treatment of
Venereal Disease during the Civil War
During the Civil War,
as in all wars, venereal disease was a major problem since it disabled
the soldier and decreased his effectiveness to fight or be moved from
battle to battle. Dr.
Freeman
Bumstead was one of the leading authorities on venereal disease
during the Civil War and his treatment of one of the most common
diseases is outlined below. A copy of his book on the topic of
Venereal Disease is a part of this collection.
Preface to the second edition with comments about
knowledge of venereal disease during the Civil War
From the Medical and Surgical History regarding
the incidence of venereal disease during the War:
"Venereal diseases were associated with
intemperance in the conditions which favored their causation. Hence they
were more frequent at the beginning and the close of the war than during
its progress, and among troops stationed in the vicinity of cities than
among those on active service. Elevations of the lines of prevalence
during the continuance of the war correspond with the accession of fresh
levies or the return of furloughed veterans. Among the white troops,
73,382 cases of syphilis were reported, and 109,397 cases of gonorrhea
and gonorrheal orchitis, giving a total of 82 cases of venereal disease
annually per thousand men, as compared with 87.86 in our army before the
war and 87.62 from the records of the ten years immediately following
the war period. Among the colored troops syphilis had an annual rate of
33.8 cases and gonorrheal affections 43.9 cases per thousand of
strength. The variations in the monthly rates are shown in the diagram
facing page 890. The lines of syphilis and gonorrhœa run courses
parallel to that of their consolidation."
Edited from Dr.
Freeman Bumstead's text-book on Venereal Disease (in this collection)
The treatment of gonorrhea must be
adapted to the general condition of the patient, and especially to the
stage of his disease. In the great
majority of oases met with in practice, acute inflammatory symptoms have
already set in at the time the patient first applies to the surgeon; but
in those exceptional cases which are seen at an early period, and in
those only, we may often succeed in cutting short the
disease by means of the treatment termed
abortive.
Abortive Treatment of the. First
Stage.—During the first few days after exposure, varying in number
from one to five in different cases, before the symptoms have become
acute, when the discharge is but slight and chiefly mucus, and while as
yet there is no severe scalding in passing water, we may resort to
caustic injections with a view of
exciting artificial inflammation,
which will tend to subside in a few days, and supplanting the existing
morbid action, which is liable to continue for an indefinite period and
is exposed to various complications. This is known as the "
substitutive," or more commonly as the " abortive treatment" of
gonorrhea. This method has been inordinately praised and as violently
attacked ; its true merit is probably to be found between these two
extremes. It is certainly liable to be greatly abused, and, if so, is
both unsuccessful and capable of producing the most unpleasant
consequences; but. when limited to the early stage of gonorrhea and used
with proper caution, it is a highly valuable method of treatment,
unattended with danger, and undeserving the censure sometimes cast upon
it.
In employing the abortive treatment,
there are several points which it is important to recollect:
1. The
disease, in the stage to which this treatment is applicable, is
limited to the anterior portion of the urethra, known as the fossa
navicularis, or extends but a short distance beyond it; it is not
necessary, therefore, that the injection should reach the deeper
portions of the canal.
2. For the treatment to be
successful, the whole diseased surface should receive a thorough
application of the injection, for if any portion remain untouched, it
will secrete matter that will again light up the
disease.
3. When once a sufficient degree of
artificial inflammation is excited, the caustic has accomplished all
that can be expected of it and should be suspended. Since a
solution of nitrate of silver, which is commonly used in the abortive
treatment, is readily decomposed by contact with metallic substances,
metal syringes should l>e avoided. Glass syringes, if well made, answer
every purpose; but, as found in the shops, they are apt to be unequal in
calibre in different parts of the cylinder, the wadding of the piston
contracts in drying and a portion of the fluid fails to be thrown out,
as is seen by its overflow when the syringe is filled a second time. For
these reasons, I never advise a patient to purchase an ordinary glass
syringe, knowing that it will probably give him much annoyance, and
perhaps prevent his deriving benefit from treatment. We have an
excellent substitute in the hard-rubber syringes, which can be obtained
at the druggists'
"No. 1 " (Fig. 1) is the one
generally sold when no special form is directed by the surgeon,
but its nozzle is objectionable; it is unnecessarily
long, its point is apt to irritate the internal wall of the
canal, and it is not well adapted to fully distend the meatus.
" No. 1, A " (Fig. 2), is
preferable. The abrupt shoulder near the point is well adapted
to fill the meatus, and the short and rounded end cannot abrade
the sensitive mucous membrane.
Fig. 3 represents another
excellent form, and one which is recommended by Prof. Sigmund,
of Vienna. I find a figure of the same in the work of Dr. H. A.
Hacker, Die Blcnnorrhden tier Genitnlien, Erlangen, 1850.
The " urethral syringe with
extra long pipe " (Fig. 4) is, in fact a syringe united to a
catheter, and is adapted for injections of the deeper portions
of the canal. The catheter portion may lie bent to any curve
desired by first oiling it and heating it over a spirit-lamp;
its form is then retained by dipping it in cold water.
The solution of nitrate of
silver, in the abortive treatment of gonorrhea, may be of
considerable strength, when only one injection will be required;
or it may be weak, and in that case should be repeated at short
intervals until the effect produced be deemed sufficient. I much
prefer the latter course, especially with patients who apply to
me for the first time, since it enables me to graduate the
effect according to the susceptibility of the urethra, which
varies in different persons. Inject the weak form of
silver nitrate and water:
Goodyear black
hard-rubber and a glass syringe
The patient should be
made to pass his water immediately before injecting, or,
better still, a quarter of an hour before. We wish to clear
the urethra of matter, and to have the bladder empty, so
that the injection may have some time to act before it is
washed away by another passage of the urine, and yet a short
interval between the last act of micturition and injection
is advisable, in order that as much of the urine as possible
may have drained from the canal and little be left to
decompose the nitrate of silver. The prepuce should now be
fully retracted, and the glans penis exposed. The latter
should be wiped dry, so as to afford a firm hold to the
thumb and forefinger of the left hand, applied laterally,
not from above downwards, and firmly compressing it
around the point of the syringe. Call the patient's
attention to the fact that the opening of the urethra is a
vertical slit; that compressing the glans from above
downwards makes this opening gajw while the compression from
side to side closes it; hence the importance of exercising
the compression in the latter way while taking the
injection. If the pressure be properly made, not a drop of
the solution will be lost, as the piston of the syringe is
slowly forced down by the forefinger of the right hand
holding the instrument, and the whole contents will be
discharged into the canal. The syringe should now be
withdrawn, and th« fluid still retained for a few seconds by
continuing the compression of the glans. When the injection
is allowed to escape, it will be found to be of a
milky-white color. This is due to the partial decomposition
of the contained salt by the remains of the urine and the
muco-pus in the canal. As this de-coin posit ion has
prevented the application of the injection in its full
strength to the urethral walls, a second syringeful should
be thrown in, and retained for two or three minutes. During
this time a finger of the disengaged hand should be run
along the under surface of the penis from behind
forwards, so as to distend the portion of the canal
occupied by the injection, and insure the thorough
application of the fluid to the whole mucous surface.
This description of the
method of using the syringe is, in the main, applicable to
all the injections which may be required in the course of a
gonorrhea; but we are now speaking of the abortive
treatment, by means of weak injections of nitrate of silver.
We will suppose that this first injection has been
administered by the surgeon, who, at the same time, has
explained the various steps of the operation to the patient.
The directions with regard to diet, etc., that will
presently be mentioned in speaking of the second stage,
should now Ik-
given ; the patient should be ordered to repeat the
injection every three hours, and, for the present, it is
best that he should be seen by the surgeon twice a day. It
is also well at this time to prescribe an active purge.
The first effect of
the caustic injections is manifested in a few hours; the
discharge becomes copious and purulent, and considerable
scalding is felt in passing water. In the course of
twenty-four to forty-eight hours, however, the discharge
grows thin and watery, and, very likely, is tinged with
blood. It is now time to stop the injection and omit all
medication for a few days, until we see how much good
has been accomplished. If the treatment meets with
success the discharge will gradually diminish, and
finally disappear in from three to five days. Sometimes,
however, after growing less, it again increases, showing
a tendency to relapse. In this case, I usually advise
weak injections of acetate of zinc, as recommended in
the third stage of the disease.
Some surgeons prefer to resume the caustic
injections in the same manner as at first if, after a
week has elapsed, any traces of the discharge remain.
The chief objection
to this modification of the abortive treatment is, that
it is necessary to leave the administration of most of
the injections to the patient, who may be prevented by
ignorance, or the requirements of his occupation, from
using them as thoroughly or as often as is necessary. If
we have reason to fear this, we may resort to a stronger
solution, and inject it once for all, with our own
hands, but I have found the effect decidedly less
satisfactory. It was this method of employing the
alwrtive treatment that was recommended by Debeney of
France, and Carmichael of England, by whom this
treatment was first introduced to the profession. The
same method is also still employed and highly
recommended by many surgeons, and especially by M. Diday
of Lyons. The strong injection should not contain less
than ten grains (0.65) of the nitrate of silver to the
ounce (30.00) of distilled water, and more than fifteen
grains are objectionable, unless with patients who have
been under treatment before, and in whom the urethra has
been found to be quite insensible.
Citations from the
Medical/Surgical History--Part III, Volume I
Chapter XI.--On Certain Diseases Not Heretofore
Discussed.
V.--Venereal Diseases.
Venereal diseases were associated with intemperance in
the conditions which favored their causation. Hence they
were more frequent at the beginning and the close of the
war than during its progress, and among troops stationed
in the vicinity of cities than among those on active
service. Elevations of the lines of prevalence during
the continuance of the war correspond with the accession
of fresh levies or the return of furloughed veterans.
Among the white troops, 73,382 cases of syphilis were
reported, and 109,397 cases of gonorrhœa and gonorrhœal
orchitis, giving a total of 82 cases of venereal disease
annually per thousand men, as compared with 87.86 in our
army before the war and 87.62 from the records of the
ten years immediately following the war period.(*) Among
the colored troops syphilis had an annual rate of 33.8
cases and gonorrhœal affections 43.9 cases per thousand
of strength. The variations in the monthly rates are
shown in the diagram facing page 890. The lines of
syphilis and gonorrhœa run courses parallel to that of
their consolidation.
The hospital records present 426 cases of venereal
disease,--53 of gonorrhœa and 373 of syphilis. Of the
former 50 were simple cases and 3 complicated with
suppurating bubo. Of the latter 194 developed no
constitutional symptoms,--among these, gonorrheal
complications were present in 41 and supurating bubo in
77. It is impossible to determine, from the language of
the record, the character of the primary sores in 179
cases which were followed by secondary symptoms. The
most notable point connected with their history is the
frequency with which sore throat, cutaneous eruptions
and other manifestations of the constitutional taint are
reported as having followed venereal sores associated
with suppuration of the inguinal glands: 19 such cases
are recorded.
Treatment as a rule was first restricted to the local
lesions, mercury or iodide of potassium being withheld
until the development of secondary symptoms. No
reference is made to scorbutic complications nor to
untoward results in constitutions undermined by the
hardships of military service. In fact, a similar series
of cases might easily have been gathered during the same
period in the wards of our civil hospitals. A few
reports on file indicate individual views of the method
of treating these diseases:
Ass't Surgeon ROBERT F. STRATTON, 11th Ill. Cav., June
30, 1862.--It was impossible to cure gonorrhœa while the
patients were exposed to the rain and had to sleep on
the damp ground and live on a salt and stimulating
ration.
Surgeon WILLIAM R.
BLAKESLEE, 115th Pa., Alexandria, Va., Oct. 20,
1862.--Gonorrhœa was greatly modified and in most cases
completely subdued by injecting a solution of chlorate
of potash, one drachm in eight ounces, every hour for
twelve successive hours, and then gradually ceasing its
use during the next two or three days by prolonging the
interval between each injection. Dietetic rules were
observed, with rest and occasionally a saline laxative.
Surgeon A. F. PECK,
1st N. M. Cav., Los Lunas, N. M., Sept., 1862.--Nearly
one-third of the cases this month consisted of gonorrhœa,
which readily yielded to treatment. With much
inflammatory action in the first stage, I generally
prescribed a saline cathartic, rest, cooling lotions and
low diet. After this stage had passed I found balsam of
copaiba, powdered cubebs and magnesia given as a bolus,
four or five times a day, to be very effectual. At the
same time I used an injection of chloride of zinc, two
to four grains to the ounce of water, once or twice a
day. When the system is much reduced tonics are
beneficial.
Surgeon ISAAC F. GALLOUPE, 17th Mass., Feb. 20,
1863.--Syphilis and gonorrhœa prevailed extensively in
the regiment during its stay in Baltimore. Rapid and
complete recovery was secured in all cases treated as
follows:--Gonorrhœa: Injections of a weak solution of
sulphate of zinc, one grain to one ounce of water, every
hour or half hour; light diet. By this treatment the
disease was always cut short, no discharge appearing
after the first use of the injection. Syphilis:
Cauterization of the chancre in the first instance,
followed by the continuous application of black wash.
All cases thus treated recovered without secondary
disease.
Ass't Surgeon P. W.
RANDALL, 1st Cal., Fort Bragg, Cal., Jan. 1, 1863.--For
gonorrhœa my treatment, which is successful, consists of
a thorough cleansing of the alimentary canal, rest, low
diet, the balsam and cubebs internally, with urethral
injections of nitrate of silver, sugar of lead or
sulphate of zinc. For syphilis I use mercurial and
saline purges, rest, low diet, iodide of potassium and
bichloride of mercury, with caustic to chancres, warts
or vegetations.
Surgeon J. G. BRADY,
26th Mass., New Orleans, La., Jan. 1, 1863.--Of the
various forms of venereal disease chancre of the non-indurated
variety is the most prevalent. It is accompanied in a
majority of cases with bubo. The sores yield readily to
cauterization with acid nitrate of mercury and
applications of black wash, the bowels meanwhile being
regulated and the patient kept on low diet. But one case
of indurated chancre has been observed, and this was
unaccompanied by a bubo. It was treated with mercurials
internally and pernitrate of mercury to the sore.
Sufficient time has not yet elapsed to determine whether
secondary symptoms will be developed, No case of non-indurated
chancre has been followed by constitutional symptoms.
Gonorrhœa is much less frequent than chancre, and more
obstinate under treatment. My practice has been to use
injections of sulphate or chloride of zinc;
occasionally, when there is irritability of the bladder,
I employ diuretics. The cases are prone to become
chronic. I have no faith in the empirical use of balsams
and diuretics, so long considered specifics in this
disease. I consider that, by their tendency to
over-stimulate the kidneys, they do more harm than good.
Surgeon DAVID WOOSTER, 5th Cal., Sacramento, Cal., Jan.
13, 1862.--I inoculate every case of chancre. If the
virus take, I treat locally and hygienically alone; if
it fail to produce chancre after the third inoculation,
I use protiodide. The cures in both series of cases are
generally reasonably prompt, occupying from fifteen to
rarely sixty days. I have not yet had secondary
developments in cases the primary accidents of which
have been treated at this post.
Surgeon ALLEN F.
PECK, 1st N. M. Mounted Vols., Fort Stanton, N. M., Dec.
31, 1862.--Primary: Cauterize with nitrate of silver,
after which apply black or yellow wash until the sore is
healed. Consecutive: If there is no constitutional
contraindication I give mercurials,--the protiodide
yields better results than any other preparation. If the
patient improves I continue the remedy until the sores
are healed and the induration dissipated, using at the
same time disinfecting mercurial and astringent washes.
If the system is exhausted I give tonics.
Surgeon EZRA READ,
21st Ind., Baltimore, Md., Sept. 5, 1861.--For many
years I have pursued the method of treatment by
mercurial fumigation, which deposits the mercury upon
the surface of the body when in a state of perspiration
induced by the heated vapor of water surrounding the
patient confined in a close and air-tight bath. This
treatment is commended to our consideration because it
eradicates the disease in a shorter period of time than
is required by the internal use of mercury; moreover,
when thus applied the constitutional effects of the
mercury are under satisfactory control. In primary
syphilis, after careful and thorough cauterization of
the chancre, I regard fumigation as the best method of
treating the disease, and as the most reliable means of
preventing constitutional manifestations. In the
secondary form I think it the only method by which a
perfect cure can be effected.
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