GONORRHEAL RHEUMATISM.
The treatment of this complication is not especially satisfac tory, being of a palliative rather than a curative character. The treatment for the urethritis should usually be persisted in, for, as a rule, the sooner the local condition improves, the sooner the rheumatic complication will yield. If, however, the discharge has ceased, it is best to let the urethra severely alone. When patients are debilitated, tonics, such as strychnine, quinine, iron, ar senic, and cod-liver oil are of advantage. The skin and bowels should be kept active and elimination favored by the use of pilo carpine hypodermically. Pain should be relieved by the use of opiates; hot applications and fixation of the inflamed joint are es sential for the same purpose. Should the knee be involved, Buck's extension apparatus should be applied as in ordinary forms of arthritis. The application of fifteen or twenty leeches to the joint will often prove serviceable. Flannels wrung out of hot water and sprinkled with turpentine form a useful application to the inflamed joint. As the inflammation subsides, blisters or iodine will be found to promote resolution. Mercury and iodide of potassium internally are of great
service in the chronic stage of the disease. The author has had ex cellent results from intra-articular injections of iodoform emulsion. It is well in all cases to try the effect of the salicylates, inasmuch as the rheumatic or gouty diathesis may exist as a predisposing cause of the disease. The more important joints, such as the knee, are best treated by the plaster-of-paris bandage as soon as the acute inflammation has subsided. Passive movement, and perhaps meas ures to break up ankylosis, are required in the later stages of the affection. Turkish and electric baths, static electricity, friction and massage are serviceable adjuvants. Static electricity is particularly beneficial. The author has been much impressed with the value of this remedy in neglected cases of chronic enlargement of the joints. During the acute stage of gonorrhoeal rheumatism a milk diet is very essential.
The ocular complications of gonorrhoea belong to the province of ophthalmology, and their treatment does not concern us here.