LOCAL MEDICATION IN ACUTE URETHRITIS.
Local medication in acute urethritis is best accomplished by means of injections.
A great deal of discussion has been evoked regarding the advisa bility of the injection method of treatment in gonorrhoea. There is a deep-grounded, and in many instances, it must be confessed, justi fiable, prejudice against their use entertained by the laity, and inci dentally by some surgeons. It is supposed by many that the injec tion method is usually responsible for stricture and other untoward complications and sequels of urethritis. While this prejudice is undoubtedly founded in some instances upon a substantial basis, the author ventures to assert that it is the abuse and not the use of in jections that is responsible for their unpleasant results. Injections of simple water, if improperly used, may produce injury, and it is certainly true that unreasonably strong astringent or antiseptic drugs will, as a rule, produce unpleasant results. Any injection of a strength sufficient to produce severe pain is probably strong enough to destroy the already partially devitalized epithelium upon the surface of the mucous membrane, and as a consequence there must necessarily occur at various points localization and intensifica tion of the inflammatory process. Given at the proper time and in a proper manner and strength, injections are not only harmless but very beneficial and really prophylactic of stricture and other complica tions; by limiting the severity and duration of the inflammatory pro cess. Any form of injections which is given for the purpose of cutting short the disease during the height of the inflammation is apt to produce injurious results. It is an unfortunate fact that many surgeons have joined in the popular prejudice against injections, for, as a consequence, nearly every patient who has stricture resulting from a gonorrhoea which has been treated by the injection method, no matter how skilfully and beneficially, attributes the permanent injury of the canal to the treatment of his urethritis; should he con sult a surgeon of anti-injection proclivities, be is certain to have his erroneous ideas confirmed, much to the detriment of the reputation of his former surgeon, who perhaps treated his urethritis upon strictly scientific and conservative principles.
One of the most important points in connection with the injection method of treatment is the selection of an appropriate syringe. The ordinary glass syringe, or the hard rubber syringe with a long nozzle, is perhaps responsible for more prolonged cases of urethritis than any that could be mentioned. The introduction of such instruments, even when performed very carefully, invariably excites more or less mechanical irritation, and it is not unusual to detect in long-standing cases a congested and granular patch of mucous membrane precisely at the spot upon which the nozzle of the syringe impinges during injection. Very few surgeons devote much attention to the instruc tion of the patient in the proper use of the syringe, or to the selection of an appropriate form of this instrument. The author has seen not a few cases of chronic urethritis which subsided imme diately upon the cessation of the use of faulty syringes. In some cases a cure will result from the use, with a proper syringe, of the same astringent solutions which have failed to produce any effect whatever when injected through one of the long-nozzled abominations. The best form of syringe is that with a conical point, known as the "Excelsior-P," manufactured by the Goodyear Rubber Company. The instrument must be of moderate capacity in order to accomplish any benefit; if it does not contain sufficient fluid to thoroughly dis tend the urethra when thrown into the canal with a moderate degree of force, the medicament is never brought in contact with the entire dis eased surface. In using the syringe, the patient should be instructed to urinate first, and thus clear away the purulent secretion as far as possible, and then to inject the fluid slowly and steadily into the canal. Too great or spasmodic force is liable to drive the fluid—and, with it, germ infection—into the deep urethra and produce prostatic, vesical, or testicular complications.