English
The predisposing cause to inflammation of these parts is the difficulty or impossibility of cleansing them, especially when the foreskin is long and narrow. The active cause may he the retained pus or irritat¬ in'? substance.s of cronorrhea, chancroid, secretions of primary or secondai’y syphilitic lesions, or the decomposition of the accumulated smegma mixed Avith urine and perhaps leucorrheal discharge added to it in coitus. The existence of vegeta¬ tions under the prepuce provokes balanitis especially when the lodgment of the gonorrheal pus excites the inflammation. Balanitis may occur also in diabetic patients, on account of the ready decomposition of their sugar-laden urine, and a certain fungus, for it is found in the smegma under the prepuce. The treatment of balanitis consists chiefly in the establishment of cleanliness, and if the prepuce can be retract' ed, this will usually suffice to cure. Parts may he washed with warm Avater of mild boric acid solution, but strong antiseptics are not deskable 404 . ANCIENT HINDU MEDICINE as before they can exert their germicidal effect, they are apt to provoke further irritation of already inflamed surfaces and cause the necrosis of the delicate cells, thus postponing their recu¬ perative power. “Excess in coitus ( simple urethritis may be provoked, especially in gouty diathesis ), contin¬ ence (herpes progentitalis and reflex nervous irritability ), coitus with a nun or one who has had no sexual intercourse for a long time ( urethritis if the vagina is not kept clean ), with a menstruating woman ( menstrual blood has been regarded as an etiological factor of urethritis from remote antiquity in diverse lands. The menstrual fluid, unless decomposed or mixed with the products of bacterial evolution of one .kind or anothei’, whether the germs be autogenetic or heterogenetic, is inconsequential— can nob possibly pi’oduce urethritis. Apparent contradictions are due to the autogenesis of urethritis in a previously damaged urethra, or to the Avashing down of the products of an old infection from the upper portion of the female sexual tract by^ the out-flowing menstrual secretion ) or coitus with a woman whose vulva is long-haired, coarse-haired, thick-haired or there is hair in the vulvar orifice(abrasions, excoria- DISEASES 405 tions, fissure or fine cuts made by sharp edges of the hair at certain angles by the copulative paroxysm¬ al movements when the genital organs are in intumescent state, are the necessary and favor¬ able conditions for the venereal germs when deposited there, to grow and multiply. Chan¬ croidal, syphilitic or gonorrheal germs can not cause a lesion unless they can find a lodgment and form a colony, otherwise they will be wash¬ ed away by the mucous and the urinal discharges. It is only when there is an abrasion, cut, wound, tear, rent or solution of any kind of the mucous membrane, that they can find an entrance, and in the delicate epithelium, with its warmth and moisture, they find it very favorable to multiply to destroy the cells, and invade the economy in syphilis), with a woman of narrow or large vulvar orifice ( strain and injuries may be caused by narrow orifice and a flabby large vaginal passage is indicative of some disease or the reac¬ tion of the diseased condition of the genitals, as otherwise in the normal state there should be vs^inal muscular contraction by the sexual stimuli and the passage of tire penis ), with an unpleasant or repulsive woman (venereal diseas¬ es, especially syphilis causes many disfigurements of the body), with a woman who makes lavation 406 ANCIENT HINDU MEDICINE of her Vcigina vrith contaminated water, or one who does not make any lavation of her vagina at all, or a woman who has a genital disease, or who has a chronic lesion in her genitals, or unna¬ tural intercourse ( sodomy does not necessarily cause any lesion unless there is an infection in either party, or venery ; excess might cause ene. ration and its reflex reactions on the orga¬ nism, thus predisposing to any infection ), injury to the penis by neils, teeth, toxic cantha- rides, compression, masturbation or bestiality (no infection can take place unless there is contact with some venereal pathogenic virus, except it might cause local injuries and pyogenic infection ), ablution of the penis with contami- n:)ted water, or its strangulation, or retention of urine or semen, or non-lavation ( uncleansing) of the penis after coitus—all these causes produce the derangement of the ‘vayiC, and provoke the inflammation of the penis, whether it has been wounded or not ; this is called *iipatlamsa'. There are five kinds of ‘upadamsa, each infection originating from five different kinds of contagions of women. Scaliness (roughness), ulperation of the skin, torpor of the penis and inflammation with in¬ duration takes place in ‘vata'Upadapisa''{syphilitic DISEASES 407 dtaucre ; The initial lesion is first seen as a papule, varying in size from a pea to a Lean, pinkish-brown in color, dry and scaling, impart¬ ing a slight resistance to the touch, which appears after an incubation of two to four weeks in syphilis, three to seven days in cliancroid (which is of diagnostic value in distinguishing chancre frem chancroid) after suspicious coitus or contact, and which slowly ulcerates with slightly inflamed and indurated, circumscribed or oval edges, leaving a superficial or eroded depression, haviilg a thin serous or sero-purulent secretion, or it may be covered with a thin grayish pellicle). Fever (as a reaction of the organism against the invasion of syphilitic ‘Spirocheta pallida’) and intumescence like the color of ‘Ficus glomevata’ (which is pinkish-brown, tlie color of chancre) develop, and which rapidly ulcei'ates with ‘pitta’ pain in ‘pUta-upadamsa’ (Ulcerating chancre). ^ Intumescence is pruritic, hard and shiny with slight {slesma) pain, in slemsa-tipadvisa) '(chancre in the first stage). A dark tumor which bleeds excessively with fever, burning, and emaciation with all 'pitta' symptoms, and which sometimes (spontaneously) 408 ANCIENT HINDU MEDICINE cures, is called ‘rakta upadamsa' (angioma of the penis on a large artery). The intumescence ulcerates with the develop¬ ment of germs, which might bring about death, with all the symptoms of the corruption of the three humors in ^sarvva-upadamscd (syphilitic sore).” Snsi'uta II. 12. 7-13 ‘‘The contagion (syphilitic ‘Spirocheta pallida’) infecting the tissues and the blood, causes their gifhTtiftcre^i ^vri^ m II 'SI eta arfa% qia^a' 'ra'x-sitw ftftvp?. arataai: ii farroqt: ftat^ara ii t f 355?^: qtiiytia qtfea: f 'tt'^aav 11 \ \ 3 rq!^ 2 qiatq 1 ssia*re^?ia: fqafti'rrWi aqicaift aiW a qtarfta 11 aw; fefam^wKt fa 11 u g^pa’fteTT, f^ia^aa, 1 DISEASES 409> pruritis; from pruritis develops sore ; irv the sore malignant nodules are formed^ enveloped in a film-like membrane, and from it exudates a viscous serous fluid (when* the syphi¬ litic process dips down into the subcutaneous tissue, and is complicated Avith indurating edema, the chancrous erosion becomes covered with 'indurated nodules\ Avhile if the sore remains- superficial and compact, the induration is spread out into a disk-like mass and is called parchment^ like chancre. Parchment-like chancres are mostly found on the integument of the penis and some¬ times on the vuh’’a. 'Indurated chancres’ are mostly found in the sulcus coronarius, parti¬ cularly near the frenum. When, owing to- excessiA'e cell-increase, the chancrous erosion becomes salient above the level of the parts, it is called ‘ulctis elevatum’. Ulcus elevatum be¬ comes covered Avith a film-like membrane, having a color Avhich is a mixture of cream^ ^ith a light-green tint A\'hich degenerates into- brownish black, if the membrane is not shod and exists for a long period. But if an antiseptic or iodoform is used, it melts aAA'ay, leaving an erosive chancrous surface. This is known as ‘chancre with the cream and the green-colored, membrane). This (chancrous nodule) kills 410 ANCIENT HINDU MEDICINE virility and destroys the penis {phagedenic chancre) ; the lesion infecting the vulva of woman produces soft, foul-smelling, umbrella- like (circumscribed) nodular chancre from which a viscid serous fluid exudates; and this contagion ascending upward, produces gummata in the ear, eye, nose and tiiroat. The gummata of the ear cause deafness, otalgia and suppuration of the ear (gumma of the auricle leads at times to deep ulceration and destruction of cartilage ; gummata on themembratie tympani occasionally cause the destruction of the membrane with ulceration ; condylomata of the meatus causes severe pain with tension and fullness and deaf¬ ness may be produced merely by the mechanical closure of tlie meatus, but the drum membi’ane occasionally becomes inflamed and may suppurate. Suppurative inflammation (Otitis media suppurativa) occurs in syphilitic subjects as the direct result of the syphilitic manifesta¬ tions in the naso-pharynx, and also from other causes, but the syphilitic dyscrasia is a serious complication). In the (gummatous syphilitic) affection of the eye there is obstruction of the palpabra (Tarsitis syp!ulitica = gummatous infil¬ tration of the tarsus ; ulcerated syphilitic mucous patches on the free margin of DISEASES 411 the lower eyelid is commoner ), offclialmagiH.