Proper treatment of gonorrhmal rheu matism consists in treating the discharge itself. The gonococci must be destroyed at their point of origin, where they mul tiply and infect the organism generally. The best means is by permanganate-of potash irrigations. The treatment is more effective in early eases; but if the joints have been affected for long, it often fails. In such obstinate eases the joints may be injected with 1 in 4000 perchloride of mercury. In suppurating cases arthrotomy is indicated. Rendu (La Med. Mod., No. 102, '96).
In the treatment of gonorrhmal rheu matism every means should be ex hausted for the purpose of shortening the attack of gonorrhcea. So far as in ternal treatment is concerned, large doses of from 45 to 60 grains of salic vlatc of sodium combined with one of the balsams are useful. In the chronic cases iodide of potassium often does good. The local treatment consists in immobilization of the limb, the applica tion of ice-bags upon the painful part, and the application of soothing oint ments which also possess a resolvent in fluence. The following may be used: 1 Salicylic acid, Oil of turpentine, Lanolin, of each, 2 drachms.
Lard, 3 ounces.
In chronic cases counter-irritation, massage, electricity, and turpentine baths are to be used, and the patient recommended to resort to some hot springs. Should there be considerable effusion into the joint, compression may be used for its absorption, or, if the effusion becomes purulent, it should be carefully aspirated, and by means of the same needle 60 to 90 minims of a 1 to 4000 solution of corrosive sublimate should be injected. Should the articular inflammation become exceedingly severe, an arthrotomy is indicated. Balzer (Jour. des Prat., Apr. 11, '96).
Syrup of ferrous iodide recommended in gonorrhmal rheumatism, the initial dose being 30 drops, three or four times a day, gradually increased, if necessary, drop by drop, until 1 drachm is given. Rapid improvement follows in most cases. J. C. Wilson (Penna. Med. Jour., Sept., 1900).
The diseased extremity is to be se cured in a proper position, and the pain may be alleviated by poultices, the use of narcotics, ointments of ichthyol, bella donna, etc. When the acute pain has subsided, compression is useful, and after some time the mobility is to be restored by massage, passive gymnastics, baths,—especially hot-air baths,—etc.
The best treatment for gonorrhoeal rheumatism is wrapping the joint with a cloth saturated with a solution of bichloride of mercury, 4 grains to the ounce, and surrounding the cloth with oiled silk. Rapid recoveries claimed without internal treatment. C. B. Hutchins (Med. World, Jan., '93).
It is advisable in all acute inflam mations of the joints to examine the urethra. In 90 per cent. of the cases urethritis will be found. The cases may be divided into four groups: first, where effusion alone occurs; second, where there is formation of fibrin and thicken ing of the capsule; third, periarticular phlegmon, with impairment of the ac tion of the tendons and elasticity of the ligaments; fourth, where ankylosis oc curs very early. Puncture of the joints and the injection of a solution of ear bolic acid advised. If there is a peri articular affection, the joint should be opened and washed out. K6nig (Samml. klin. Vort., No. 70, '96; Boston Med. and Surg. Jour., July 7, TS).
Surgical measures—aspiration, early incision into the joint—have given rise to excellent results. In twenty cases treated by Bres an incision was made into the joint, the diseased synovial membrane was removed, and dilute tincture of iodine or a weak solution of chloride of zinc was injected. All his cases recovered completely.
Cure of an acute, suppurative, norrhagic arthritis by aspiration and in jection of 3 hypodermic syringefuls of bichloride of mercury (4 to 1000). Rendu (Le Bull. AIM., Mar. 24, '93).
Case of gonorrhoeal arthritis in which incision was made over the outer edge of the patella, the capsule of the knee joint was reached by dissection, and 10 ounces of thin, brownish, sero-purulent fluid were evacuated. The cavity was explored with the finger, and several fibrinous flakes turned out; it was then thoroughly flushed with normal salt solution. Sterile wicks were passed through and the cavity again washed out. After the second douching the wound was closed and a dry dressing, with compression, was applied and the limb placed on a ham-splint. The pa tient was dismissed cured in seventeen days. Homans (Boston Med. and Surg. Jour., Dec. 29, '9S).