ABORTIVE TREATMENT TO URETHRITIS.
The abortive method of treatment has been generally understood to imply the substitution of a simple for a specific inflammation. This practice is a relic of bygone days, which has impelled surgeons of excellent reputation—and undoubted wisdom in other directions— to rub the pure crayon of nitrate of silver in eyes affected by viru lent conjunctivitis. It is even possible that there are surgeons at the present time who advocate this very method of treatment for this par ticular disease. During the author's term of service as hospital in terne, he saw pure nitrate of silver applied on several occasions, and in every instance it was followed, not by the substitution of a simple for a specific inflammation, but by complete destruction of the eye as far as its visual capacity was concerned. The author remembers asking one of the hospital staff who applied this method of treatment in a case of virulent ophthalmia, under the advice of a prominent specialist, how he knew which had destroyed the sight, the disease or the treat ment. He replied that it was impossible to say positively, but that it must be the disease, because "they all went that way anyhow.", Arguments are useless as opposed to such logic as this, but it is hoped that it is unnecessary to protest against such pernicious doc trines as applied to the treatment of urethritis. _ The abortive method of treatment as applied to urethritis should properly imply, not the fossilized and sophisticated idea of the sub stitution of one type of inflammation for another, but (1) the removal as far as may be of the virulent germs which have been deposited upon the surface of the mucous membrane, and which, although they have begun to manifest their pres'ence by slight irritation at the meatus or just within it, have not yet deeply penetrated into the substance of the mucous membrane and infected the subjacent cells ; and (2) the neu tralization of the germs and their products by means of antiseptics or germicides—which in this instance imply all chemical substances capable of neutralizing the organic poison of urethritis without de stroying the mucous membrane.
These requirements are the more readily fulfilled because the dis ease begins at the meatus, or at most in the fossa navicularis, and gradually affects contiguous areas of mucous membrane. The sub
stance most generally used in the abortive method of treatment is nitrate of silver. This may be used in two ways : (1) By the injec tion of a mild solution at frequent intervals; (2) by means of a single injection of a comparatively strong solution. If properly done, and at an appropriate period in the incipiency of the disease, either one of these methods is usually safe and is not likely to result in stric ture—the principal danger of the abortive method. A solution of nitrate of silver, fifteen grains to the ounce, may be thrown into the canal by means of a small drop syringe, which is passed into the urethra for about two inches, the fluid being ejected as the syringe is slowly withdrawn. It is held in the urethra for a few seconds, and a weak solution of chloride or bicarbonate of sodium is then thrown into the canal, the patient being instructed to urinate immediately thereafter. If this be carefully done when slight discharge and itching at the meatus are first observed, the method is apt to prove successful and is devoid of danger, although in general it is not a good method for application by the general practitioner. In lieu of the strong preparation, a solution of one-half grain of nitrate of sil ver to the ounce of water may be given and used every two hours for twenty-four hours or less, the treatment being stopped as soon as pronounced smarting during micturition develops.
That nitrate of silver is efficacious in destroying the materies morbi of virulent inflammation is shown by the excellent results ob tained by Crede in the prophylaxis of ophthalmia neonatorum by the instillation into the eyes of the new-born infant of a two per cent. solution. of that drug. While the use of the nitrate of silver in care less hands is inimical to the welfare of the urethra, the author is satisfied that, if properly used, its dangers are greatly exaggerated. Injections in a strength of thirty grains to the ounce may often be used in chronic urethritis, with the best possible results. Such in jections, however, should only be given by the deep syringe.