Study of 236 cases of gonorrhoea treated in the course of one year, using solutions of protargol, per cent. in strength for the first 2 weeks, increas ing gradually if the secretion persisted. Ninety-nine of these cases had their first attack, and from these he deduces his statistics. The time required to ob tain a cure ranged from 5 to 43 days. In 34 of these cases there were compli cations. Comparing his series of 670 eases treated during 1896, the average duration of the all aek was no better with protargol than with other methods of treatment. Its only advantage is that it is somewhat less painful. Nies sen (Miinchener med. Wochen., Mar. 19, 1901).
The writer has used silver vitellin (protargol) in the local treatment of gonorrhoea. It is absolutely free from any irritating properties, solutions as high as 5 per cent. causing no discom fort. The gonococci on and beneath the urethral mucous membrane are rapidly destroyed. The amount of urethral dis charge is at once lessened in a marked degree in the majority of eases. The actual duration of the disease is shorter than is obtained by the use of any other silver salt. In the writer's series of eases 3S were cured in from two to four weeks. IT. M. Christian (Medical Rec ord, Sept. 27, 1902).
After the patient appears to be well, his habits should be guarded for a few weeks, as the discharge may recur again from sexual excess, overindulgence in alcohol, etc. In some instances of the disease in the subsiding stage the dis charge seems to be kept up by treatment. This should be borne in mind, and guarded against. Cases that persist for two or three months usually exhibit localized areas of infection in some of the urethral follicles or pouches, superficial ulcerations, or even beginning stricture formations, and call for a care ful urethral exploration.
The question as to what the physician shall say to a gonorrhoeal patient who wishes to marry may be summarized as follows:— If the presence of Neisser's gonococci is demonstrated, the physician's duty is clear. But, if the bacteriological exam ination is negative, his answer should cover the following points:— As a negative bacteriological examina tion is not an absolute proof of the ab sence of gonococci, it is the patient's first duty to make an earnest and sustained effort to rid himself of the gonorrhma or chronic inflammation of the urethra by a systematic course of specific treatment.
This is not to be neglected even in cases where the examination has for a long time repeatedly failed to detect gonococci.
If a complete cure is found impossible, or if the patient refuses to subject him self to further treatment, the physician should explain the case under its various aspects, and leave the decision with the patient. In no ease is the physician to assume the responsibility of the gonor rhma not becoming infectious.
If the patient decides to marry, the physician should impress upon him the fact that he is still capable of giving the infection, and must, therefore, observe the following rules in sexual inter course:— 1. Urinate immediately before sexual congress to expel any secretion that may have accumulated in the urethra.
2. Avoid as much as possible having intercourse oftener than once a day.
3. Never perform the act twice in suc cession, because, if the first seminal dis charge contains gonococci, the friction attending the second coitus brings them into closer contact with the urethra and cervix, thereby increasing the danger of infection.
If this rule is disregarded, and the act is performed more than once in twenty four hours, the vagina should be thor oughly flushed out with a vaginal douche, which should, in general, be employed as often as possible. Kromayer (Munch. med. Woch., No. 24, '9S).
A previously cured case of gonorrhwa gives a certain amount of immunity to a patient. The older the man, the less his liability to gonorrhma. After the age of thirty a man who has had gonorrhma may in many cases safely have sexual connection with women who would be certain to communicate it to younger men and to men who4e urethras have not been rendered to some degree immune by previous gonorrhma. I. N. Bloom (Amer. Bract. and News, Sept. 13, '9S).
Gonorrhcea in Women.
The gonorrhoeal process in women af fects, in the order of frequency, the ure thra, the cervix uteri, the vulva, and the vagina. While in adult life the vagina is the seat of the disease but rarely, before puberty an infection with gonococci is most apt to cause an inflam mation of this canal. This is to be ex plained by the resistance offered by the vaginal mucosa of the adult to this micro-organism. The diagnosis in any case is established if gonococci can be demonstrated in the discharge. Their absence, especially in the chronic forms of the disease, does not, of necessity, ex clude the specific origin of the disease. In cases of true gonorrhoea the patient must be warned against infecting the eves.