RATIONAL OR METHODICAL TREATMENT. The rational method of treatment is of necessity the one which we are most often called upon to prescribe, for the reason that, as a rule, the patient rarely seeks advice until urethritis is well established.
The term "rational" is used in contradistinction to the expect ant method of Fournier, Diday, and others, which consists chiefly in the administration of placebos.
In cases of simple urethritis, mild measures of treatment may be directly curative, which cannot be said of the more active types of the disease. Attention to genito-urinary hygiene, regulation of the diet, the administration of mild laxatives, and the use of weak astrin gent injections usually suffice for the cure of the milder cases within a few days ; at least, such measures check the discharge. From what has been said of the causes of the simple forms of inflammation of the urethra, it is obvious that in the majority of instances surgical treatment is necessary for a complete cure, either in conjunction with medical treatment or following the cessation of the urethral discharge. Thus dilatation or cutting operations are required for stricture; the contracted meatus must be cut and congested and granular patches must be stimulated to repair by means of applications through the endoscope, or other measures applicable to the treatment of certain forms of chronic gleet must be instituted.
So intimately connected are simple urethritis and chronic patho logical conditions of the canal that it is unnecessary to discuss further the treatment of what must obviously be in the majority of instances merely a symptom. The author sometimes wonders whether it would not be safe to distinguish broadly simple from virulent urethritis by saying that the simple form comprises the effects of venereal excite ment, intemperance, and contact of irritating secretions or a special poison with a canal at one time affected with severe inflammation, while virulent inflammation is the result of inoculation of a highly elaborated poison upon the virgin urethra, with or without the co operation of the other factors just mentioned. The author is tempted to believe that an individual who has once had a virulent attack of urethritis becomes so insusceptible to the disease that infection, when taken alone, never thereafter causes a virulent type of inflammation, apparently virulent (secondary) attacks being due to the super-addi tion of some extraneous source of irritation. This may seem far fetched, but let it be remembered that the subsequent history of the gonorrhoeal patient is usually a succession of comparatively mild attacks. Is this because he is more choice in his selection of females? But, it may be urged, "the mild attacks are due to pre-existing dam age in the canal," i.e., remnants of the old attack. Very true, but
wherein do such lesions protect the patient from virulent attacks, if exposure be granted—as it must be in most cases? The most important principle in the management of severe urethri tis is the maintenance of physical and sexual rest. It would be fair to qualify the statement that there is no specific for urethritis by saying "with the exception of absolute rest," so great is the benefit to be derived from it. It is an unfortunate circumstance that individuals with gonorrhoea labor under the fatuitous idea that the disease is in itself not a serious one—as they usually express it, "no worse than a cold,"—and it is consequently difficult, indeed it is impossible, in the majority of cases, to induce them to take a complete rest. They wish to be cured promptly, but upon entirely different principles from those which govern the management of other acute inflammatory affections. A man with a sharp attack of urethritis is certainly very sick, yet how seldom can he be induced to take to his bed and be treated upon the same rational principles that are carried out in other inflammations ! A man with a fractured limb is of necessity com pelled to rest, and independently of the mechanical obstacle to move ment, it is not difficult to convince him that absolute quiet is neces sary for a cure. There is little or no danger in a simple fracture, yet the patient is perfectly tractable. There is great danger, usually, in cases of virulent urethritis, yet it is seldom possible to convince the patient that quiet is necessary. A moment's reflection will con vince the reader of the truth of the assertion that there are few dis eases indeed that are characterized by so many and such severe remote pathological possibilities as is that under consideration. Many a man, crippled at middle age, and whose life is ever after afflicted with numerous physical annoyances or perhaps serious bodily infirmities, is indebted therefor to a severe attack of gonorrhoea experienced in his youth. The immediate results of a gonorrhoea are often bad enough. There is nothing more painful than an attack of epididymitis, a disease which may produce sterility, and in certain constitutions may lead to abscess or gangrene and total loss of the organ involved. This complication is among the most frequent re sults of urethritis. Inflammation of the bladder, of an acute and dangerous form, is occasional, and is productive of much suffering. Should the bladder become involved in any degree, it is indeed a for tunate individual who is not ever thereafter annoyed with vesical irri tability, or perhaps chronic inflammation. Prostatitis also leaves disagreeable and usually permanent effects.