During the increasing stage of urethritis, injections, if used at all, should be very mild—they may usually with advantage be dis pensed with altogether at this time. A solution of bichloride of mer cury in a strength of from 1-30,000 to 1-15,000, in combination with a small amount of glycerin, is about the best routine injection for use at this period. Some cases appear to be materially benefited by it, but in many it will be found to be too irritating and, temporarily at least, harmful. Even in the cases in which it is beneficial, it ap pears to lose its effect in from two or three to ten days, and it be comes necessary to substitute for it some of the ordinary astringents in mild solution. It is possible that its evil effects are due to a pe culiarly destructive influence upon the epithelium. It is always more markedly beneficial in simple than in virulent urethritis.
It has sometimes occurred to the author that astringents often serve to prevent the normal evolution of urethritis by condensing the tissues and sealing up—so to speak—the avenues of germ elim ination.
In lieu of the bichloride injection during the increasing stage, an anodyne injection may he given, the following being useful formulw : In the stationary stage of the affection the strength of the astrin gent injections may be slightly increased. It would appear that it is not so much the form of astringent as the method of its use that determines the beneficial effects. It will be found that a number of different astringents will give about the same average results when properly used, although in some cases it will be found necessary to vary them. The most popular astringent drug is the sulphate of zinc, and this will be found beneficial in quite a large proportion of cases. Personally the author prefers the sulpho-carbolate or iodide of zinc to the sulphate. The nitrate of silver in a strength of one eighth to one-half of a grain to the ounce of water is often of great service. Some recommend it as the best routine injection.
The following illustrative combinations will be found to be useful: The vegetable astringents are often to be preferred to those of a mineral character. Matico, hydrastis, catechu, kino, and like drugs are very popular, and are dependent upon the tannic acid which they contain. The muriate of hydrastin is especially popular and very often efficacious. A favorite vegetable astringent in the author's practice is the fluid extract of hamamelis virginica. The following formula has proved of great service: As the inflammation begins to decline, the strength of the injec tion selected may be increased, sometimes to double the proportions given. This should be done very cautiously, however, and in no instance should an injection be continued when it is found to produce considerable pain. Nothing more than a slight smarting is warrant able. In some cases the use of the injection does not produce much immediate discomfort, but it is fduncl that smarting during micturi tion increases. Under such circumstances either the strength of the
injection should be diminished or some other form of medicament substituted for it. This proposition is especially pertinent as applied to injection of the bichloride of mercury; it will be found that with this drug in a strength of even one-sixteenth of a grain to the ounce, patients will complain in a day or two, not of pain following the injection, hut of severe smarting in micturition.
Sulphate of thallin is often of service in a strength of 20 grains to the ounce of rose-water.
Iodoform has been used to a considerable extent in the treatment of acute urethritis, but, as far as the author's experience goes, it does not seem to be superior to, or even as efficacious as, many other drugs, and its disagreeable odor more than counterbalances any possible beneficial effects. In the chronic forms of the disease, however, it may be used with advantage, if the patient can be in duced to disregard its tell-tale odor.
A form of treatment which has been highly recommended is the insertion of soluble bougies of various types of medication. The author is satisfied that this method of treatment is not only illogical, but is very injurious in acute urethritis, for any suppository of sufficient stiffness to permit of its introduction into the urethra is capable of producing mechanical irritation. As an additional ob jection, there is no form of soluble bougie which can be practically applied by the majority of patients. There exists, also, the not in considerable danger of exciting inflammation of the deep urethra, prostatic and vesical complications, and epididymitis. The author has seen several of these complications in consultation, which he has been inclined to attribute to the use of the bougies, and in experiment ing with them in his own practice he has had on several occasions unfortunate results. It is certain that it is impracticable to combine germicide drugs with the bougies in sufficient strength to completely neutralize the virus of the disease, and inasmuch as the bougie necessarily carries with it more or less of the poison into the deeper portion of the canal, it is obvious that an extension of the inflamma tion is apt to result. The author does not wish to be understood as absolutely condemning the use of soluble bougies, for in the chronic forms of urethritis they are often of service. It must be confessed, however, that even in these cases the bougie is of benefit chiefly through a primary increase of irritation of the canal, as a conse quence of the mechanical stimulation which it produces. The author, therefore, rarely uses them, excepting in exceedingly chronic cases in which he considers it necessary to "wake up," so to speak, the inactive mucous membrane.