Stricture, the most important of the sequelm of gonorrhoea, is pro ductive in some instances of the most profound pathological disturb ances in the proximal portion of the genitourinary tract. Inflamma tion of" the bladder, calculous disease, inflammation and dilatation of the ureters, surgical diseases of the kidney, and even Bright's disease of the ordinary form, are often directly traceable to it. There are very few individuals who have suffered from pronounced stricture, who are not affected either with renal disease or with what is prac tically the same thing, a locus minoris resistentice in the direction of the kidneys, which favors the development of acute or chronic Bright's disease from apparently trivial causes. There are few cases of gon orrhoea, indeed, but affect to a greater or less extent the prostate body, and it is the author's view that many individuals who in after-life are afflicted with prostatic hypertrophy owe that condition to the effects of an early gonorrhoea.
It needs but a casual survey of the morbid possibilities of urethri tis to convince one that it is a serious affection. It is an undeniable fact that gonorrhoea is the most dangerous of the venereal diseases, for through the medium of its sequelm and complications the disease is the cause of more deaths than can be justly attributed to the direct or indirect influence of syphilis. By comparison, chancroid is essen tially a benign disease. Subtract the evil effects of gonorrhoea from the list of human ills, and the resulting increase in the longevity and happiness of the race would be something marvellous.
It is the author's belief that every patient with a virulent urethritis should be confined to his bed for from one to two weeks, and that, if this could be accomplished, the majority of cases would not only be subdued within two or three weeks, but stricture and other com plications and sequelaa would be almost unheard of, providing the medical and surgical treatment adopted in conjunction with rest were not in itself productive of injury. In the comparatively few instances in which the author has been able to carry out this plan, the results have invariably substantiated this opinion. Sexual rest is a positive necessity, and it is hardly necessary to state that this implies both mental and physical sexual repose. The mind must be kept free from sexual impressions and ideas of all kinds.
Second only in importance to rest is attention to diet. A restricted regimen is necessary, not only because of its beneficial effects from an antiphlogistic standpoint, but for the purpose of limiting the waste products excreted with the urine. It is upon the amount and charac
ter of these waste products that the irritating properties of the urine depend, and there is nothing so efficacious in diminishing its acridity as attention to diet, the ideal regimen being bread and milk. Stimulants, such as alcoholics of all kinds, tea and coffee, should be interdicted. The more closely a vegetable diet is adhered to the better, providing a bread-and-milk regimen be not acceptable. Asparagus and tomatoes, however, are to be avoided.
It is not considered necessary by the majority of surgeons to re strict the patient in the manner of indulgence in tobacco. Chewing is probably not at all injurious, but this is not true as regards smoking. Practical observation shows that smoking, unless in extreme modera tion, is decidedly inimical to the cure of inflammatory troubles of the genitourinary tract. It is well, therefore, to prohibit it as a matter of routine. Some of the author's patients have acknowledged that they have themselves noticed a difference in their condition according to the extent of their indulgence in tobacco. The late Dr. Bumstead held the opinion that both smoking and chewing produced relaxation of the genital organs and tended to perpetuate urethral discharges. Tobacco in excess certainly makes the nervous system irritable and tends to promote sexual excitability. The evil influence of smok ing upon the mucous membranes is probably not limited to those of the nose and throat, but also extends to all the mucous tracts of the body through the constitutional effects of the weed.
The alkaline mineral waters should be given for the purpose of diluting and increasing the bulk of the urine. To these mineral waters may be added the citrate, acetate, or bicarbonate of potas sium with the object of still further lessening the irritating prop erties of the urine by neutralizing its acidity. Profuse diuresis, providing the urine is bland and non-irritating, is highly desirable, for the urethra is like an infected wound in a certain sense, and requires frequent irrigation for the purpose of cleansing the infected surfaces.
Cleanliness is absolutely essential, and individuals with a long prepuce should be particularly cautioned to cleanse the parts beneath it thoroughly, and, if possible, to retract it and bathe the glans several times daily, to prevent balanitis and further cultivation of the pro ducts of virulent inflammation.