Instillations of antiseptic and astringent remedies by means of the deep urethral syringe come next in order. They are highly extolled by many of our genitourinary authorities, yet nevertheless they are often disappointing. As made with an ordinary Illtzmann syringe the application of a few drops of nitrate of silver solution to the prostatic urethra for the cure of follicular prostatitis, or so-called posterior urethritis, is the height of absurdity. The area medicated by the solution is but a small part of that which is infected, and a few drops of a more or less powerful solution of nitrate of silver are not likely to accomplish much good. Where the instillation method is used at all, it should be by means of a syringe holding a drachm or two of fluid. The orifices in the injecting tube should be numerous, this ar rangement enabling the fluid to escape in the prostatic urethra simul taneously in all directions, flushing this portion of the canal thor oughly. Such a syringe is very convenient in cases where we desire to leave a certain quantity of antiseptic or astringent fluid in the bladder. Nitrate of silver, bichloride of mercury, sulphate of thalline, and choloride of zinc are the most reliable of the remedies in vogue for instillation. Astringent and antiseptic remedies applied by means of ointments or soluble bougies are often of marked service. Iodo form is probably the most valuable medicament for use in this man ner. Nitrate of silver in combination with lanolin, five to twenty grains to the ounce, is also frequently efficacious. Local medication of the prostate via the rectum is also of service. Iodoform, europhen, and ichthyol in combination with anodynes are often found efficacious in assisting in the cure of the chronic inflammation. They are espe cially indicated where well-marked diffuse inflammation exists. In such cases also massage of the prostate and seminal vesicles via the rec tum sometimes proves beneficial. Counter-irritation to the perineum in the form of blisters is one of the most valuable adjuvants to the treatment. Frequently repeated hot rectal injections in combination with hot sitz-baths are of service. In obstinate cases, prolonged rest
in bed meets a very important indication. Many cases of chronic in flammation of the prostate may be completely cured in this manner. Few cases indeed will resist from four to eight weeks' complete rest in the recumbent posture. Due attention should be paid to the con-. dition of the bowels. Hepatic torpor especially must be counteracted. The pelvic circulation, in short, should be kept as active as possible by appropriate remedies. In very serious cases of well-marked diffuse chronic inflammation, a cure may be brought about in a large proportion of instances by putting the prostate and neck of the blad der completely at rest by means of combined suprapubic and peri neal section with through-and-through drainage. Drainage by the perineum should be kept up for a couple of weeks, after which time the suprapubic opening alone is to be relied upon. Speedy subsidence of the prostatic inflammation is to be expected in most cases. The author unhesitatingly recommends this method of treatment in born cases, especially those occurring in men at or about middle age.
It is unnecessary to enumerate the various internal remedies which are likely to prove of value. Anaphrodisiacs, ergot, and most of the other remedies which have been enumerated as efficacious in hyper trophy of the prostate, and some of those recommended in acute in flammation of the organ, may any of them be quite beneficial.
One of the most important points regarding chronic inflammation of the prostate is the fact that the follicular form of gonorrhoeal origin may afford an infectious secretion for a prolonged period. A pa tient who has been apparently well for many months may infect the female, not necessarily with true gonorrhoea, but with some form of mucous inflammation which is a derivative of the original true speci fic process. The patient should be duly impressed with this feature of his disease, else he may not appreciate the necessity for prolonged treatment and attention to hygienic rules.