Venereology

VENERELOGY (from Latin Venus-Venus, goddess of love, and Greek logos-science), the science that studies venereal, or sexual diseases, i.e., diseases that are acquired, predominantly, through sexual intercourse. At the dawn of syphilology, in 1527, Jacques de Bétancourt, the first to introduce the term 'venereal diseases', described among them the most diverse diseases that are acquired through sexual intercourse. At the present time, the subject of V. includes: a) gonorrhea (trippere, or clap); b) chancroid, or venereal ulcer, and c) syphilis, the study of which is called syphilology or syphilology. Many authors under the name of additional venereal, or 'paravenereal', diseases also include here: 1) condyloma acuminatum; 2) lymphogranuloma venereum, or Nicolas-Favre disease; 3) erosive-circinate balanoposthat of Bardal (1890), described by modern German authors under the name of erosive-gangrenous balanitis, and 4) pustulo-ulcerative balanitis of Ducastel (1891). History. The overwhelming majority of authors who studied the history of V. based on all possible primary sources agree that gonorrhea was known in deep antiquity. This assertion is based: a) on separate paragraphs of the biblical book of Leviticus, which gives the most elementary medical-sanitary information, where it speaks of the 'uncleanness' of a man suffering from a discharge that soils his body; of the 'uncleanness' of his bed and any 'place' on which he sat, 'uncleanness' which ceases only a week after recovery, when he, having washed his body and clothes, must appear in the temple and bring an expiatory sacrifice and prayer for the 'sin'; b) on medical treatises of the Greek and Roman epochs, vaguely describing the symptoms of urethritis as involuntary discharges of semen (and pus) without erections, but not mentioning, however, either the causes of its occurrence or its contagiousness. More clear and definite descriptions of acute urethritis and its local complications are found in the Indian collection of Susruta (beginning of our era), among Arab and Arabist physicians of the 9th, 10th, 11th centuries, such as Rhazes, Mesue, Avicenna, etc., in the treatises of famous representatives of the Salernian school, such as Roger and Lanfranc (13th century), the Oxfordman John of Gaddesden (13th century) and others, who already developed the technique of treatment up to wearing a suspensory and even outlined elementary preventive measures, such as washing after intercourse, etc. Guy de Chauliac (at the end of the 14th century), Valescus of Taranto (beginning of the 16th century) and others already definitely testified to the sexual origin of urethritis, clarifying its symptomatology and therapy. The clear awareness by authorities of the venereal danger from public women is evidenced by the medieval sanitary-police measures of the Bishop of Winchester, Queen of both Sicilies Joanna, and others.- Various ulcerative lesions of the external genital organs, accompanied by abscesses in the groin, were undoubtedly known to ancient Greek and Roman authors, since they are mentioned by both Hippocrates and Galen, but particularly detailed by Celsus (last quarter of the 1st century B.C. and first half of the 1st century A.D.). From this, most historians of medicine conclude the ancient existence of chancroid. 'Eating' ulcers of the sexual parts, 'pustules' of the glans penis are vaguely described by Arabists. From the 13th century, mainly from the time of William of Saliceto, indications of venereal ulcers become more definite, since the authors already clearly speak of the sexual origin of these ulcers. Thus, V. as a separate branch of medicine was formed by the end of the 15th century, by that period when a new, unseen and unheard-of factor, which absorbed all the attention of the medical world, appeared on the scene, unanimously testified by all contemporary medical treatises - the pandemic of syphilis, which exerted a harmful two-century influence on the further development of V. Under the then deplorable hygienic conditions and then morals, cases of mixed infections with all venereal diseases were, it is permissible to think, extremely frequent, which obscured the clinical picture of each of them and led observers into error. First appeared treatises on gonorrhea 'Gallic' (i.e., accompanied later by symptoms of syphilis) and simple; then treatises that already considered any gonorrhea as a symptom of syphilis. The same happened with chancroid. As early as 1508, Bell began to teach about the identity of the virus that produces both types of chancr and differing only in the degree of its 'activity'. Even the great A. Paré did not escape the influence of the spirit of the time, but as an observant clinician, the absence of general symptoms of syphilis, following chancroid with suppurating buboes, he attributed only to the fact that the 'venereal' poison is communicated to the liver, from where the 'strongly expulsive ability' throws it out into the groin with the aim of expulsion from the organism. And only one Fallopius (1555) hotly but vainly protested against the confusion of both chancrs, pointing out that 'suppuration (in the groins), known even to Hippocrates, is not inherent in the Gallic disease, which produces in the groin tumors unknown to the ancients'. By the 70s of the 16th century, the confusion of all venereal diseases became complete and was recognized as a scientific dogma, and mercury treatment as a specific remedy against the single venereal poison became a panacea. Along with this, the study of the clinical picture of syphilis, the development of techniques for its treatment and the study of ways of its transmission impress with their accuracy. As early as 1497, Gaspar Torella clearly described the induration of the base of the ulcer. Grünbeck (1500) sets forth the details and plan of treatment; Jacobus (of Catania, 1504) confirms the presence of latent periods of the disease; the famous Fernel, Fallopius and Fracastor give the symptomatology of syphilis by periods, etc. The latter author also created the very name 'syphilis' (1530). The 17th century brought no progress to V., and most writings of this time only contain vague reasoning about the nature of the venereal 'matter', about the mechanism of the action of mercury, guaiac, etc. The first three quarters of the 18th century, among the abundance of treatises on venereal diseases, count only a few works marking the beginning of true progress. A. Didier (1724) of Montpellier put forward the theory of microscopic 'worms' as producers of venereal 'illness'. Astruc (1740) gave an amazing for its erudition multi-volume venereological treatise, based on the study of literally all the existing literature on syphilis up to him, and first proclaimed that the poison of syphilis spreads through the blood and that the course of the disease depends on the individual 'resistance' of the patient. He was the first author of this era to make a weak attempt to distinguish between gonorrhea and syphilis, noting that the first 'never causes syphilis, unless the semen or seminal fluid infected with the virus has abundant and free drainage'; Van Swieten, on his part, gave the first clear and precise clinical description of syphilis, and Lebert (1770) was the first to study syphilitic infection from a patho-anatomical point of view and gave the first treatise on both visceral and congenital syphilis. English science rendered the greatest service to V. in this century. Halfour in a series of works (1767) and B. Bell (1793) firmly and clearly defended the complete independence of gonorrhea (while the latter for the first time described a chancre in the urethra), and their teaching found lively echoes and followers in different countries of Europe, especially in Germany. Unfortunately, their famous countryman John Hunter, the first physician to introduce the experimental method into medicine and already strictly distinguishing between soft and hard ('Hunterian') chancrs, inclining toward the independence of gonorrhea, for the purpose of testing on himself, performed the notorious inoculation of urethral pus, which resulted in the development of a hard chancre with its usual consequences, which actually delayed the recognition of truth for another half a century. At the very end of the 18th century, Schedelauer, who created the term 'blennorrhea', experimentally caused catarrhal urethritis by injecting ammonia into the canal, thus laying the foundation for the doctrine of the non-contagiousness of gonorrhea. The next decisive step in the separation of gonorrhea were the Toulon experiments of Hernández (1812), who, by injecting under the prepuce of 17 convicts pieces of cloth soaked in gonorrheal pus, caused gonorrhea in them. The actual finisher of all these works and popularizer of the idea of the independence of gonorrhea was F. Ricor in the 1830s, who from 1831 to 1837 by means of hundreds of inoculations 1) indisputably proved the independence of gonorrhea and 2) at the autopsy table established the existence of chancrs in the urethra as the cause of the notorious 'Gallic' gonorrhea. Like his predecessors, Ricor denied the contagiousness of gonorrhea and in this respect met with hot opposition from the viralists-representatives of the Lyon school with J. Rollet and Didot at the head. The discovery in 1879 of gonococci by Neisser, their subsequent cultivation by Bumm (1885), successful inoculation of their culture into the urethra, etc., restored the ancient truth about the contagiousness of gonorrhea. It is necessary to note in passing that the adherents of Bell's teaching, German venereologists from Autenrieth (1809) to Eisenmann (1830), with their teaching on the 'trippere diathesis', did much for the future clinic of gonococcal sepsis.

Among the attempts that aimed to establish an etiological difference between the viruses of hard and soft chancres, the works of Carmichael El (1814) deserve attention, who objected to recognizing any ulcers of the sexual parts as syphilitic, regardless of their external appearance, character, and distinctive features, but, unfortunately, his theory of 4 viruses, with their specific clinical manifestations, was too clinically vague, and thus made no impression. In 1831, Simon (Hamburg) provided an interesting historical study on ulcers of the sexual parts, teaching that not all of these ulcers lead to the manifestations of syphilis. A student of Günther, who recognized only the chancre with a hardened base as 'venereal', Ricor, in his numerous inoculations, while confirming this fact, strangely did not attach essential significance to it and taught about the identity of the viruses of both chancres, and by making inoculations only on syphilitics, he also made another error: he denied the infectiousness of secondary manifestations of syphilis. The inoculations introduced by Ricor became part of the usual medical practice, and in the 1840s a whole school of so-called syphilizers arose, who inoculated themselves and others with all sorts of products of so-called syphilis. From these experiments, when compared with clinical data and confrontation, among a multitude of various errors, both false interpretations and methods of treatment, three major truths emerged: 1) the independence of soft chancre was recognized, which is mainly to be attributed to Ricor's student Basro and the Lyon school, which ardently supported him in the persons of Rollet and Didot (1852); 2) the infectiousness of products of secondary syphilis was established, first confirmed by Waller (Prague, 1851); 3) the theory of mixed chancre was created, with remarkable clinical talent developed in 1858 by Rollet and ardently supported by Berensprung (Berlin), who, along with Virchow, began the histological study of syphilides. Further stages in the development of syphilidology—the brilliant clinical study of the symptomatology of syphilis, carried out especially by A. Fournier (1858-1906); the beginning of the experimental study of syphilis—Metchnikoff and Rou (1903); the discovery of Treponema pallidum—Schaudinn (1905); the Wassermann-Neisser-Brook reaction (1907); the introduction into therapy of arseno-Senzo by Ehrlich (1909); Noguchi's works on para-syphilis (1913); the introduction of bismuth into syphilotherapy (1922), etc.—Stages in the development of the theory of soft chancre: 1889—discovery of streptobacilli by Ducre; 1900—obtaining a pure culture of streptobacilli (Besançon, Griffon); 1913—attempts at vaccine therapy (Ito); 1923—attempts at serotherapy (Reinshirna); 1924—methodology of vaccine therapy and vaccinodiagnosis (Nicole and Durand). Schools. The beginning of the first venereological school as an institution created for the study of syphilis in women and their children can be considered the Vaugirard hospital in Paris (in 1780). Individual representatives of it, especially Bertin, gave a number of treatises of considerable practical importance in the history of the study of congenital syphilis. The true creator of modern scientific venereology was F. Ricor in the Paris hospital La Midé in the 1830s-1840s, who, not being satisfied with clinical study alone, widely applied the method of inoculations and thus proved that the discharge of gonorrhea is incapable of causing either syphilis or soft chancre. The first venereological school created by Ricor served as an example and impetus for the creation of similar schools in other cities of France, especially in Lyon, and in all countries of Western Europe. From these schools emerged and acquired historical significance: the Paris schools of A. Fournier (hospital Saint-Louis) and H. Moriac (hospital La Midé), the Lyon school—Didot and J. Rollet, the Berlin school led by Berensprung, the Florentine school with Pellicari at its head, the Vienna school with Sigmund and others. In the pre-war period, in connection with new biological trends in syphilidology, the Breslau school of Neisser acquired great importance, from which came a number of fundamental works on experimental syphilis and the creation of the seroreaction, and the Vienna school of E. Finger, where the pathological anatomy of gonorrhea was studied in detail and in recent times the methodology of malaria therapy for early syphilis has been developed. In Russia, the father of Scientific V. must be recognized as V. M. Tarnovsky, who, after graduating from Moscow University in 1859, began in 1860 to work in the spirit of new Ricorian ideas in the Kalinkin hospital in St. Petersburg, where he created the first Russian venereological school; the success of the latter was partly the reason that on November 15, 1869, the conference of the Military Medical Academy passed a resolution on the establishment of an independent department of V., which Tarnovsky occupied in 1871, the first professor of syphilidology in Russia. A major contribution of the Tarnovsky school is the development of questions about the influence of parents' syphilis on the succeeding generation, about the character and causes of malignant syphilis, about late congenital syphilis, about serotherapy of syphilis, about the influence of heat on the resorption of specific infiltrates, about the so-called provocative cauterization, the phenomena of which revealed facts of the allergic condition of the skin of old syphilitics, etc. In Moscow, independently of other disciplines, teaching of V. was begun by N. P. Mansurov in 1864 and became mandatory only from 1870, when in the Novo-Ekaterininskaya hospital a university, meager and poor, clinic of skin and venereal diseases was established, at the head of which hastily prepared D. I. Naidenov became. His successor from 1883 became Mansurov. The actual founder and leader of the Moscow school must be considered A. I. Pospelov, who, in 1876, at the head of the material-rich Myasnitskaya city hospital, established there a special feldsher school and with his innovative methods in diagnosis and treatment quickly gained popularity and attracted a large audience of doctors and students. From this school, transferred in 1895 to a newly built, excellently equipped clinic, came a number of works concerning extragenital infection of syphilis, public prevention of it, the clinic of chancre of the cervix uteri, syphilitic myxedema, syphilitic diabetes insipidus, syphilitic leukoderma, iodine-arsenotherapy of malignant syphilis, etc. Unforgettable services to Russian syphilidology were also rendered by the Kiev school of M. I. Stukovenkov (1890s) and the Warsaw school, now in Rostov-on-Don, of P. V. Nikolsky, to whose credit must be placed the scientific development of the principles of mercury therapy of syphilis and its rationalization. A new era in the field of V. began with the creation in 1925 at the State Venereal Institute in Moscow of the first department of social venereology in the USSR. This department summarized the experience accumulated since the organization of the People's Commissariat of Health and the department for the fight against venereal diseases at it, thereby laying the foundation for the school of social V., which, along with sociological research, took upon itself and developed the methodology of the public fight against venereal diseases. Social V. had an undeniable influence on the clinical study of venereal diseases, clarified the paths of prevention and contributed to the wide propaganda of new methods of treatment of venereal diseases (abortive treatment of syphilis and gonorrhea, etc.). Methods of development, teaching. The progress of V. and its modern major scientific and practical successes are due to the skillful combination of methods of clinical and clinical-statistical research, into the use of which has now entered the study of immunobiological reactions and endocrine-vegetative symptoms with laboratory-experimental research, concerning mainly pathological anatomy, bacteriology and hemato-serology, further—with socio-statistical research, closely connected with the modern broad state fight against venerealism. This fight inevitably requires: 1) mandatory acquaintance of every physician with both elementary V. and with the methodology of the fight against venerealism as a social evil; 2) the presence of a sufficient cadre of physicians possessing special knowledge in both the scientific and practical fields of V. Depending on these requirements, in the USSR—1) the system of university teaching of V. has been reformed: students study it for two years during their 4th and 5th years and during this period, in seminar-group sessions, they become practically acquainted with the clinic of venerealism and the methodology of necessary laboratory research;—2) in a number of major centers, properly functioning courses for the improvement of physicians in the field of V. have been created;—3) in Moscow, Odessa, and Kharkov, special scientific-research state venereal institutes have been established, with attached venereal dispensaries, in which, along with experimental-laboratory research, teaching of social V. is also carried out. The development of questions of V. is greatly assisted by special societies existing in many larger cities, either independently or as branches of general medical societies. These societies were called into life by the pressing necessity of collective discussion of complex clinical observations in special hospitals, which is why in almost all places their organizations preceded medical conferences, which gradually expanded and involved in their circle of activity physicians of other institutions.

The first specialized society in Europe was established in 1885 on the initiative of Tarnovsky and now exists in Leningrad as the Russian Syphilidological and Dermatological Society, bearing the name of its founder. Later, similar societies were established in Berlin, Paris, and other major scientific centers. The second specialized society in Russia was the Moscow Venereological and Dermatological Society, which began its work in 1891 and was established on the initiative of its first chairman, A. I. Pospelov. At present, similar societies exist in all university centers of the USSR. Special congresses have played and continue to play a major role in the development of V., bringing together venereologists from individual regions, the entire country, or all cultural countries to collectively address specific current issues. The first international venereological congress took place in 1889 in Paris. Later, international congresses were periodically convened every three years in various capitals of Europe and America. Unfortunately, the imperial war made it practically impossible to convene international congresses, which were replaced by congresses covering only representatives of individual groups of European states. In the post-revolutionary period in the USSR, two all-union venereological congresses were organized (the first in Moscow in 1923, the second in Kharkov in 1925).-Each cultural country' at present has one or more specialized journals devoted to the development of ven. science. The first attempt to publish a specialized journal was made in the late 1840s in Paris, but it was not very successful. Only in the late 1860s, almost simultaneously in Vienna and Paris, the now existing 'Archiv fur Dermatologie u. Syphilis' and 'Annales de dermatologie et de syphiligraphie' appeared, which later acquired some international significance. The first specialized journal in Russia was the 'Russian Journal of Skin and Venereal Diseases' published by I. F. Zeleny from 1901 to 1917. Shortly before the war, V. V. Ivanov founded in Petersburg the journal 'Dermatology' on a broad program, which was interrupted by the outbreak of the military storm. Since 1924, two specialized journals have been published in the USSR-'Venereology and Dermatology' (published by NKZdr.) and the 'Russian Herald of Dermatology', the organ of the Moscow ven. and dermatological society.-Museums of photographs, drawings, radiograms, and especially moulages, which give a plastic representation of various lesions, primarily of the skin, have great scientific, teaching, and educational significance. The first such museum in terms of time and abundance of collections is the museum at the St. Louis Hospital in Paris, existing since the late 1860s, which soon after its founding found imitators in all cultural countries. The richest museum of moulages in the USSR is the museum founded by A. I. Pospelov at the Clinic of Skin Diseases of the Moscow State University, containing over 800 specimens of the exemplary work of the moulage maker S. P. Fiveisky. Color illustrations, both watercolor drawings and especially moulages from various European museums, appear in the pages of numerous special atlases published in various countries, an excellent collection of which, as a gift from N. P. Mansurov, is kept in the Clinic of Skin Diseases of the 1st Moscow State University. A successful and praiseworthy attempt to reproduce the vivid color photographs not from moulages but from living objects was made in 1922 by the Munich syphilidologist Zumbush (Leo von Zumbusch) by publishing a special atlas. In all cultural countries of Europe and America, many hundreds of all kinds of textbooks and manuals on general V., as well as studies on individual aspects of the field, are published annually. The rapid progress of V., the expansion of its pathological boundaries, the clarification and deepening of diagnostic and therapeutic methods, etc., inevitably lead to the publication of collective textbooks and especially encyclopedic guides, an example of which is the multi-volume 'Handbuch der Haut- u. Geschlechtskrankheiten' published under the editorship of Jadasson. The initial venereological guides that appeared in Russia in the late 18th and early 19th centuries were exclusively literal translations of foreign works and sometimes by little-known authors. Only in the 1870s did Tarnovsky give the Russian medical world both an original guide on female gonorrhea and a translation of Lancerot's exemplary treatise on syphilis, abundantly supplemented with his own valuable notes. If in the pre-revolutionary time the scarcity of original Russian venereological guides on our book market was striking, despite the relative abundance of translated works, especially German textbooks, then the post-revolutionary upsurge gave, along with a sufficient number of original guides (Nikolsky, Grigoriev, Kholtsov, Kreps, Raits, etc.), no small number of translated textbooks with critical remarks by editors-textbooks not only German but also French and English. Along with this, it is necessary to note the appearance of monographs treating various aspects of social V., for example, N. L. Rossiisky's guide on the methodology of venereological dispensaryization. The useful educational work of publishing popular brochures, posters, and textbooks has shown remarkable growth in recent years. All this undoubtedly indicates the rapid progress of native V. and the growing interest in it from our physicians and the Soviet public, thirsting for enlightenment.