with its old bridge and canal of the 17th century, a museum, and iron foundries, tanneries and match and paper factories.
VENERABLE (Lat. venerabilis, worthy of reverence, venerari, to reverence, to worship, allied to Venus, love; the Indo-Germ. root is wen-, to desire, whence Eng. “win,” properly to struggle for, hence to gain), worthy of honour, respect and reverence, especially a term applied to dignined or honourable age. It is specifically used as a title of address given to archdeacons in the Anglican Church. It was naturally a term of respectful address from early times; thus St Augustine (Epist. 76, 88, 139) cites it of bishops, and Philip I. of France was styled venerabilis and venerandus (see Du Cange, Gloss. s.v. Venerabilitas). In the Roman Church the granting of the title “venerable” is the first step in the long process of the canonization of saints (see Canonization).
VENEREAL DISEASES (from “venery,” i.e. the pursuit of
Venus, the goddess of love), a general term for the diseases
resulting from impure sexual intercourse. Three distinct
affections are included under this term—gonorrhoea, local contagious
ulcers, known as chancres, and syphilis. At one time
these were regarded as different forms of the same disease.
They are, however, three distinct diseases, due to Separate
causes, and have nothing in common except their habitat.
The cause in each case is a definite specific virus, a micro-organism.
In the case of gonorrhoea the virus attacks the
mucous membranes, especially that of the urethra, the vagina
and the uterus. Chancres attack the mucous membranes and
the skin. In syphilis the whole system comes under the influence
of the poison.
Though these three affections are generally acquired as the result of impure sexual intercourse, there are other methods of contagion, as, for example, when the accoucheur is poisoned whilst delivering a syphilitic woman, the surgeon when operating on a syphilitic patient, the wet-nurse who is suckling a syphilitic infant, and so on. An individual may be attacked by any one or any two of the three, or by all at the same time, as the result of one and the same connexion. But they do not show themselves at the same time. In other words, they have different stages of incubation. In gonorrhoea the disease appears very rapidly. So also in the case of the soft chancres, the first symptoms commencing as a rule three or four days after inoculation. It is different, however, with syphilis, the period of incubation being twenty-eight days, though it may be much longer. The length of the period of incubation, therefore, is of great diagnostic help in the case of syphilis.
For many years the term “venereal disease” was used very loosely, though the writers before the year 1786 had a tolerably clear idea that three distinct diseases were included under the term: the lues venerea, now called syphilis, gonorrhoea, and a condition leading to bubo and associated with a multiple chancre which is known at the present day as “soft sores.” John Hunter, as the result of an unfortunate experiment, taught that there was but a single venereal poison which manifested itself in different ways. It took the French school many years of hard work to show that the poison of syphilis was distinct from that producing a soft sore, and that the virus of a soft sore was incapable, when pure, of causing gonorrhoea.
The evidence brought forward by Ricord, by Lancereaux and by Fournier was convincing. It has been confirmed by bacteriology, and it has happened by a remarkable coincidence that the truth of the French teaching about syphilis was first established on the firm basis of experiment in France itself, when Professor Metchnikoff at the Institut Pasteur in Paris gave in his adherence to Schaudinn’s work, which showed that the Spirochaeta pallida germ was the cause of the disease.
A. Gonorrhoea.
Gonorrhoea is a specific inflammation of the mucous membrane of the urethra and other passages, by the reception into it of germs known as diplococci (διπλόος, double; κόκκος, berry—the germs being double, like the halves of a walnut). After the illustrious discoverer, the germ is often spoken of as the gonococcus of Neisser. Gonorrhoea is apt to be a very serious disease, and it sometimes ends fatally.
The germs find entrance during coitus and multiply at enormous rate, spreading to all the glands and crevices of the membrane, and setting free in their development a toxin which causes great irritation of the passage with inflammation and swelling. They remain quietly incubating for three or four days, or even longer; then acute inflammation comes on, with profuse discharge of thick yellow matter, with much scalding during micturition, and there may be so much local pain that it is difficult for the person to move about. Microscopic examination of the discharge shows abundant pus corpuscles and epithelial cells from the membrane, together with swarms of diplococci (gonococci).
The inflammatory process may extend backwards and give rise to acute prostatitis (see Prostate Gland), with retention of urine; to the duct of the testes and give rise to acute epididymitis (swollen testicle) ; and to the bladder, causing acute cystitis. It may also cause local abscesses, or, by irritation, set up crops of warts.
The treatment of acute gonorrhoea is best carried out if the patient can lie up for a while. He must avoid all fermented drinks and rich foods, and sexual and other excitement, and he should drink freely of such things as barley-water, in order to dilute, and lessen the irritation of, the urine. Hot baths are comforting. Laxatives should be freely given. The urethra should be frequently washed out with a warm solution of permanganate of potash, a grain to the pint, and, later, a weak solution of one of the zinc or silver salts may be used as an injection.
Capsules of copaiba or oil of sandalwood, and a paste of cubebs pepper, have a beneficial influence, and, later, if the man is depressed, quinine and iron will be found useful.
In ten days or a fortnight the inflammation gradually subsides, a thin watery discharge remaining which is known as gleet. But inasmuch as this discharge contains gonococci it may, though scarce noticeable, set up acute specific inflammation in the opposite sex.
In the case of the female the inflammation is apt to extend to the uterus and along the Fallopian tubes, perhaps to give rise to an abscess in the tube (salpingitis) which, bursting, may cause fatal peritonitis.
A lingering gleet may be due to the presence of a definite ulceration in the urethra, as shown by examination with a slender tube illuminated by electricity—the endoscope. The ulcer having been induced to heal by the application of a nitrate of silver lotion, all discharges cease. Chronic inflammation is necessarily associated with the formation of interstitial fibrous tissue, and the contraction of this new formation causes narrowing of the urethra, or stricture. Thus gleet and stricture are often associated, and the occasional passage of a large bougie may suffice to cure both. Often, however, a stricture of the urethra proves rebellious in the extreme, and leads to diseases of the bladder and kidneys which may prove fatal.
One of the most important points in the management of a case of gonorrhoea is to prevent all risk of the septic discharge coming into contact with the eye. It sometimes happens that the patient inadvertently introduces the germs into his own eye by his finger, or that his eye, or the eye of some member of the household, becomes inoculated by the use of an infected towel. If this happen, prompt and energetic measures must be taken to save the eye.
If so be that at the time of delivery a woman be the subject. of gonorrhoea, there is great probability of the eyes of the infant being affected. The symptoms appear on the third day after birth, and the disease may end in complete blindness. The name of the disease is ophthalmia neonatorum (see Blindness).
By the term gonorrhoeal rheumatism it is implied that the gonococci have been carried by the blood stream to one or more joints in which an acute inflammation has been set up. It is apt to occur in the third week of the disease, and it may end in permanent stiffness of the joints or in abscess.
In rare cases the germs find their way to the pleura or pericardium, setting up an inflammation which may even end fatally.
For a man to marry whilst there is the slightest risk of his still being the subject of gonorrhoea would be to subject his wife to the probability of infection, ending with chronic inflammation of the womb or of septic peritonitis. Yet it is often extremely difficult to say when a man is cured. That there is no longer any discharge does not suffice to show that he has ceased to be infective. Nothing less than repeated examinations of the urethral mucus by the microscope, ending in a negative result, should be accepted as evidence of the cure being complete. And these examinations should be made after he has returned to his former ways of eating, drinking and forking.
B. Local Contagious Ulcers.
