INTERNAL MEDICATION IN ACUTE URETHRITIS.
The range of application of internal medicaments in acute ure thritis is not very extensive, the so-called specific remedies being espe cially limited in number. During the increasing stage of the disease there is apt to be considerable fever, and the tincture of aconite or veratrum virile will be found to be useful. The author believes that these remedies are not used sufficiently often.
Alkaline diluents should always be given throughout the course of the disease, either alone or in combination with other drugs. The fluid extract of pichi (Fabiana imbricata), a drug recently put upon the market, appears to have an excellent effect in lessening the irri tating properties of the urine and soothing the inflamed mucous mem brane. Combinations of buchu, slippery elm, uva ursi, linseed, etc., are all beneficial, especially if given in infusions, their action in this disease being essentially the same as in inflammation of the bladder. The ergot of rye and the ergot of corn (Malay° maidis) have been , recommended as exerting a specific effect upon the disease. In the early stages of the affection ergot does not seem to be of any particu lar service, and, moreover, is very disagreeable to take. In the later stages of the affection, however, it undoubtedly exerts an astringent influence upon the inflamed surface, and may be given in quite lib eral doses, with marked benefit in some cases.
The fluid extract of corn silk (Stigmata maidis), in doses of one drachm every two or three hours, has been highly recommended in the treatment of the acute stage of gonorrhoea. The author has failed to notice any special benefit derived from this remedy in acute gonorrhoea. It has, however, seemed to be beneficial in some cases of catarrhal gleet.
It is desirable to administer some anaphrodisiac preparation dur ing the height of the disease for the purpose of allaying sexual ex citement and producing a direct sedative influence upon the inflamed part. A dose of twenty to thirty grains of bromide of potassium at bedtime has usually the desired effect. If a more powerful effect is desired, the following mixture will be found serviceable : Either of these combinations will usually allay sexual excitability and prevent or relieve severe chordee. It may be necessary,.how ever, in some cases in which erections are painful and troublesome, to administer an opiate. Opium has a certain degree of stimulating effect upon the sexual organs, which rather detracts from its efficacy as an anodyne in these cases. This objectionable feature may be avoided by combining the deodorized tincture of opium in moderate doses with either chloral or the bromide of potassium. Where these
various remedies prove unsuccessful, the cold-water coil will invari ably afford relief and has in addition a decidedly beneficial effect upon the inflammation. If the patient sleeps upon a hard bed, with a knotted towel applied about his waist in such a manner that he cannot comfortably lie upon his back, painful erections are not so apt to occur.
Morphine is sometimes necessary, and is best given by supposi tory, plain or in the following useful combination: The remedies most relied upon in the treatment of gonorrhwa are the various balsamic preparations. These should not usually be given during the increasing stage of the disease, and it would seem that more marked benefit is to be derived from them when they are not used early in the case. There is, perhaps, no objection to the administration of the oil of sandalwood in the increasing stage; cubebs and copaiva, however, are more stimulating, and consequently inadvisable at this time. Sandalwood oil is best administered in the form of capsules containing from ten to fifteen minims. Of these, from four to ten may be given daily. In lieu of the capsules the pure oil may be given in doses of ten to fifteen drops upon a lump of sugar, this dose being repeated four or five times daily. The limit of tolerance is usually indicated by stomachic disturbance, or quite frequently by pain in the back resembling lumbago, this being probably nephralgia dependent upon over-stimulation and consequent irritation of the kidneys. Sandalwood is much more likely to pro duce this result than are copaiva and cubebs. During the stationary and declining stages copaiva and cubebs may be given alone or in combination. Of these two drugs, cubebs is the most stimulating to the mucous membrane of the urethra, but least irritating to the stomach. Copaiva occasionally exerts an unpleasant effect in the form of an efflorescence or rash upon the surface of the skin, which is sometimes so pronounced as closely to simulate measles. The cause of this untoward action of copaiva is not known. It would appear, however, that the eruption is produced through the medium of idio syncrasy, by an impression made by the drug upon the sympathetic nervous system, analogous to that produced iu some individuals by the ingestion of shell fish, over-ripe tomatoes, etc. Quinine and several other drugs have been observed to produce a similar reaction • of the skin, probably in the same way. It is possible that defective renal elimination and vicarious skin action has something to do with these cases.