In a few cases of chronic gleet the author has obtained marked benefit by the use of astringent sprays thrown through the endoscopic tube by means of an ordinary Sass spray apparatus, in alternation with applications by means of the powder-blower of an impalpable powder of iodoform, boracic acid, and camphor in equal parts.
When the inflammatory process has extended to the deep or pros tatic urethra, deep injections by some method or other are abso lutely necessary. The instrument of Ultzmann or its modifications may be used for this purpose. The author has devised a More capa cious syringe than that of Ultzmann, which he prefers to any he has seen. Nitrate of silver, sulphate of copper, and sulphate of thallin are the best drugs for use in these cases of deep inflammation. Sol uble prostatic bougies and astringent ointments are occasionally of great service in posterior urethritis, i.e., follicular prostatitis.
As far as his own experience goes, the author has found the sul phate of thallin in a fifteen to twenty per cent. solution the best anti septic and astringent application for routine use in the posterior ure thra. His usual plan is to alternate the thallin with irrigations of nitrate of silver or potassium permanganate in varying strength. In some cases in which there is chronic inflammation of the bulbous urethra we may succeed in exciting healthy action by irrigating the canal with hot iodized water of the strength of one drachm to the pint. In quite a number of obstinate cases the author has had excellent results from the use of a mixture of balsam of Peru, compound tinc ture of henzoin, and iodoform introduced through the endoscopic tube : All measures of treatment of chronic gleet will fail if the surgeon does not advise his patient against various sexual, dietetic, and other general causes of perpetuation of urethritis, and if the patient does not follow these instructions to the very letter. It is an unfortunate fact that the average patient with chronic urethral disease lays the responsibility of his case upon the shoulders of his surgeon, and ex pects a cure to be accomplished without the slightest co-operation upon his own part. The capacity for deceit on the part of the average
patient with chronic urethral disease is something astonishing. It is certainly a discouraging thing to have a patient present himself with an acute or subacute urethritis a mouth or six weeks after he has apparently been cured of stricture and gleet, and have him solemnly vow that he has not played the glutton or roue during that time. It is possible that a few such patients do not lie to the doctor, but it would be difficult to convince the expert that, in the absence of an exciting cause, a canal which had been thoroughly dilated and the secretion of which had been entirely checked could spontaneously lapse into an inflammatory state at so long a period after an apparent cure. It is possible that patients with sexual difficulties are uo more deceitful than those who present themselves for the cure of other affections, but such is not the impression that the surgeon is likely to derive by observation of such cases. It might be supposed that the average individual has sufficient respect for his own physical interests to be perfectly frank and honest with his physician, and it has been aptly said that "the man who deceives his doctor is a fool." But, as far as his experience goes, the writer is inclined to believe that, if this proposition be true, imbecility is largely prevalent in our community. Whether the moral turpitude of the venereal patient is due to a sense of shame, akin to that which impels him to apply the water-closet theory to the origin of his disease when he is well aware of its true origin, or to a desire to lessen his financial responsibility to his surgeon, is a question that it would be difficult to answer. To say the least, it is safe to assume that there is no class of patients so aggravating as those met with in genito-urinary practice.