Cubebs and copaiva may he given in doses of ten to twenty drops of the oil, four or five times daily, either in capsules or in the form of an emulsion. The author prefers the emulsion where the patient does not object to it. The doses of the balsams may he increased to the limit of tolerance, but it is wise not to give them too liberally until the disease begins to decline. There are no better combina tions in the way of balsamic emulsions than the following: Cubebs may be given in powder in doses of one drachm, two or three times daily, and this method of administration sometimes agrees with the stomach very much better than either the emulsion or capsule. The formulie given are more or less illustrative, and may be varied according to the judgment of the practitioner. Vidal ad vocates the use of gurjan balsam in doses of two grammes before each meal. Dr. R. W. Taylor speaks favorably of the tincture of cannabis sativa in doses of ten to fifteen drops in water three or four times daily.
In the later stages of gonorrhoea, in which there is a tendency to chronicity, turpentine is occasionally of value, the white or Canada turpentine being the best variety. The author has obtained be,nefit in some cases from the administration of the following: In some instances in which the patient is debilitated, the addition of iron to the balsamic preparations is advisable for its tonic and astringent effect. Matico and other vegetable preparations contain ing tannin are recommended for internal administration, but the author has failed to note any benefit from these drugs, with the pos sible exception of Hydrastis canadensis, which has seemed to be of service in some cases of chronic urethritis.
The beneficial effect of the balsams when administered internally is rather peculiar, inasmuch as when locally applied by means of in jections they have apparently no action whatever. It would appear that in their passage through the digestive tract and circulation they undergo some chemical change, by virtue of which they exert a spe cial soothing effect upon the inflamed mucous membrane. That they exert any specific (microbicidal) influence over the poison of virulent urethritis is highly improbable. Their effect is certainly not consti tutional, as they are of absolutely no service in gonorrhoea in the female, unless the urethra is involved.
The local use of copaiva in its natural state does not seem to be beneficial. As a matter of curiosity, however, it may be mentioned
that it has been recommended for local use in vaginitis. 111. Baratier (These de Paris) recommends the use of copaiva in the form of vag inal suppositories for gonorrhoea in the female, these suppositories containing also the extract of opium. Inasmuch as this is said to cure "in about twenty days," it is hardly necessary to comment upon it as a means of specific medication, for certainly a remedy which would not bring about a cure in less time than this can hardly be said to be very efficacious as a specific.
The test has been made by AI. Ricord and others of injecting the urine of patients who were taking large quantities of copaiva into the vaginm of women and of men affected with virulent inflam mation, the effect being decidedly beneficial. Raquin, of Paris, has prepared a solution termed by him copaibate of soda, which is said to be useful as an injection as well as internally.
Aperient medicines are beneficial throughout the course of ure thritis, particularly during the acute stage. The saline laxatives are especially beneficial; the various natural mineral waters, notably the Friedrichshall and Hunyadi Janos,, being the best of these. The Carlsbad salts are also of service. It should be remarked in this con nection that constipation is invariably attended with more or less con gestion of the prostate, and possibly of the urethra, and its correction is therefore desirable. Bruising of the prostate during a difficult stool may constitute the point' of departure for prostatic complica tions in the course of acute urethritis.
Naphthol is a remedy recently recommended in urethritis. This agent is claimed to act by becoming decomposed and thereby con verted into some modification of phenol (or carbolic acid), which, coming in contact with the mucous membrane of the genito-urinary tract, is supposed to destroy the germs of the disease. It has been given in doses of from two or three to fifteen grains, several times daily. It would appear to be indicated in chronic vesical inflamma tions rather than in urethral troubles, inasmuch as it probably makes the urine less putrescible. It is apt to disturb the stomach, and, as the process in gonorrhoea is an active mixed infection rather than a septic process, the writer cannot appreciate its advantages over some other drugs.