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HISTORY OF

The running gleet: why venereal disease is so important to the history of urology

BY JONATHAN CHARLES GODDARD

n this series of articles I am going to show new disease first reared up during a war; Century gives treatments for gonorrhoea you some of the exhibits contained in venereal diseases do love an army. When or chaude pisse (from the French for hot the Museum of Urology, hosted on the Charles VIII of France invaded the Kingdom pee). The burning and swelling he says IBAUS website (www.baus.org.uk). You of Naples his army quickly marched down leads to “huge sorowe and prikkynge”. He might say that genitourinary infectious Italy taking Naples in February 1495. After recommends urethral injections of a variety disease is a part of urology, but allied as we the siege was broken it soon became of soothing herbs including purslane seed, are, you have to admit that GU apparent that the invading army, which water lily, parsley, oil of roses or violets, and and GU are often quite distanced. contained many Spanish mercenaries, even the milk of a woman. He also Historically however, venereal diseases had brought with them a terrible plague. suggests a scrotal support or “lytyll bagge” played a close and important part in the The disease began with horrible genital to prevent further swelling. history of urology. sores, after a few weeks generalised skin Venereal disease causes many urological The first problem we see when discussing rashes, fevers and agonising shooting manifestations, hence historical books on the history of venereal diseases is defining pains appeared, these were followed by the topic often read like urology textbooks. them. Now, with the advantage of destructive and extensive ulcers which ate John Douglas writing in 1737 gives some microbiology and virology we can identify away noses, faces and bones. It was often of the manifestations of the disease and name the that cause sexually fatal. It spread like wildfire; it was across including, dysuria, genital sores, priapism, transmitted diseases; historically, of course, mainland Europe by the end of the year and phimosis and paraphimosis, and testicular our ancestors were not even aware they had reached England and Scotland by 1497. swelling leading to sterility. A very common were infections. The three main venereal This new and terrible pestilence was blamed consequence of gonococcal of diseases were , gonorrhoea and and named on the presumed source. The course is urethral stricture (Figure 2). In the ; lues, gleet and soft sores were French called it the Neapolitan disease, first half of the 19th Century, Robert Wade some of the names given to them. The the Italians returned the compliment, the (1798-1872) was known for his expertise inability to differentiate between the Russians the Polish disease, the Turks the in treating strictures, an early urology diseases meant that healers were unsure if Christian disease. In England it was the specialist before specialities existed. By they represented one disease at different French disease or the French pox or the the end of that century, Reginald Harrison stages, one disease that affected different Great pox (differentiated from smallpox). (1837-1908), also a stricture expert, was people in different ways or at different times This syphilis was clearly a much more headhunted from Liverpool to St Peter’s of the year, or separate entities entirely. virulent version than the modern disease Urology in London; genito-urinary The second historical quandary was that we see today, and it was also different surgery by then, had become a recognised syphilis seems to appear suddenly as a to the mild non venereal version seen in speciality. terrible plague in the 1490s being absent pre-Columbian South America. The name The first endoscopes were not long or in Europe before this time. Syphilis was Syphilis appears in 1530 in an instructive powerful enough to clearly visualise the thought to have been brought over by poem by Venetian and poet Columbus’ men from the New World. This Girolamo Fracastoro (1476/8–1553 – Figure 1). In a story taken from the Roman poet Ovid, a shepherd called Syphilis blames a God for sending a drought. The God, offended by the blasphemy, sends down a terrible disease on Syphilis. Fracastoro uses the poem to describe the nature and physical appearance of this new disease. It is unclear if syphilis appeared de novo in the Old World, brought back from the New World by Columbus. There is some archaeological evidence that it might pre-date Columbus. It is possible that they brought back a new strain which manifested itself in a more virulent way to the unexposed immune systems of Europe. Certainly, there is plenty of evidence of penile ulcers, presumed to be venereal in Figure 2: Urethral stricture surrounded by the bougies used the ancient and mediaeval world. John of to diagnose and treat it. From Charles Bell’s, Letters on Urethral Figure 1: Girolamo Fracastoro. Image in the public domain. Arderne (1307–1392) writing in the 14th Diseases, 1810.

urology news | NOVEMBER/DECEMBER 2019 | VOL 24 NO 1 | www.urologynews.uk.com HISTORY OF UROLOGY

morals and at worst a direct punishment by surgery before bladder stones did. The God, is said to be one reason that urology desire to visualise the urethra led to the in England was so late to be accepted as development of better instruments to look a speciality. When St Paul’s Hospital, one beyond into the bladder. Most afflictions of the famous three P’s London urology of the lower urinary tract can be caused by (St Peters, St Pauls and St Phillip’s), or mimicked by venereal disease and thus was opened, there was an outcry from the had to be treated or excluded, hence early local residents. This was probably due to books on venereal disease or genito-urinary the huge sign in their square, “For Skin and surgery were one in the same. So venereal Genito-Urinary Diseases!” Not only a case of disease, particularly gonorrhoea (or the “there goes the neighbourhood” but surely, running gleet as it was once also called) with “there goes the Profession”. Yet, there were its chronic and usually non-fatal destruction many of the ‘new’ urologists of the early of the lower urinary tract had an important 20th Century who were happy to be involved part to play in the history of urology. in and associated with the management of Figure 3: The obstructing prostate, from John Hunter’s book venereal disease. Frank Kidd (1878-1934), the Venereal Disease, 3rd Ed. 1810. founder of the genitourinary department SECTION EDITOR bladder, however, the Desormeaux (1853) at The London Hospital, believed that no and Cruise (1865) endoscopes (maybe urologist could hope to be successful or even even the Bozzini of 1805), could visualise competent unless he was fully acquainted strictures. Desormeaux and Cruise were with venereal diseases of the urethra. the first to operate on urethral strictures The association with a sexually under direct vision. Urethroscopes preceded transmitted disease may have been one cystoscopes. factor that slowed the appearance of the It is in John Hunter’s book on venereal pure urologist in Great Britain, but it was disease that we see the early representation certainly not the main reason; the urological of the obstructing prostate (Figure 3), manifestations of venereal disease might Jonathan Charles Goddard, one cause of prostatic swelling being actually be said to have helped develop Curator of the Museum of Urology, hosted by BAUS; Consultant Urological Surgeon, Leicester General infective, hence its inclusion, but this also urology as a speciality. Of course, bladder Hospital. demonstrates the close link between stones led to the first urology operation and E: [email protected] venereology and urology. This association the stone cutters were the first specialists, with venereal problems, at best due to loose strictures however led the way in endoscopic

urology news | NOVEMBER/DECEMBER 2019 | VOL 24 NO 1 | www.urologynews.uk.com