Another important precaution to be observed is to be sure that the aniline oil-gentian-violet solution has not de composed. This solution should not be used when it consists simply of a clear fluid and a brown sediment. To avoid errors in this regard the solution should not be more than two weeks old. Oscar Richardson (Boston Med. and Surg. Jour., Feb. 7, 1901).
Abortive Treatment. — In theory the abortive treatment of gonorrhoea is ideal. It is successful, however, in the very earliest manifestations of the disease only. In practice, unfortunately, pa tients are very rarely seen at this stage.
After the gonococci have penetrated neath the superficial layers of the ure thral epithelium, and after the toms are well marked, this method should not be employed. In adopting this treatment the surgeon should be guided to some extent by the wishes of the patient, as well as by the local con dition. There are cases in which it is imperative to cut the disease short. It should be explained to the patient that the abortive treatment will be followed by considerable inflammatory reaction, and that it may fail to arrest the disease. Given, therefore, a patient who pre sents himself, within from one to three days after exposure, with a slight irrita tion at the meatus and a scant, watery discharge, the advantages and disadvan tages of the abortive treatment should be fairly presented, and, if he so elects, the surgeon is justified in carrying out this method. The technique is as follows: The patient urinates, the anterior ure thra is then washed out with sterile water or boric-acid solution, and a solu tion of silver nitrate, 20 grains to the ounce of distilled water, is applied to the first inch and a half or so of the urethra, either with a French pointed urethra] syringe or a cotton swab introducer] through an endoscope. The patient should then be treated as for the early stages of acute gonorrhoea. All the symptoms of acute anterior urethritis develop rapidly, and in successful cases, gradually subside and disappear in a few days. If unsuccessful the disease runs the usual course.
Instead of this single, powerful appli cation, frequent, copious irrigations of the anterior urethra with potassium manganate, 1 to 2000; corrosive subli mate, 1 to 5000; or silver nitrate, 1 to 1000, may be employed. By this method the patient is spared the discomforts caused by the more active treatment, but it is less likely to succeed.
A case of gonorrhma seen within eight days from the outset can be aborted. For the first five days a 2- to 4-per-cent. pro targol solution is used, and during five days following 1 to 2 per cent. Two in jections of about 5 to 10 drops are given daily, and the solution is kept within the urethra for from ten to fifteen min utes each time. In I00 eases, gonococci were present at the commencement in every case. In 1i3 cases they were not found after the first day, in 15 not on the third day, and in 9 not at the end of 7 days. Ahlstrom (Hygeia, Dec., '99).
Abortive treatment based upon a study of thirty cases, most of which were cured in from eight to ten days. A specimen of the discharge is taken for microscopical examination; then the patient passes urine, after which the urethra is washed out with hot water twice a day, and a 10-per-cent. solution of argonin, freshly made, is introduced by an Ultzmann deep-injection syringe, or, better still, by a rubber bulb hold ing about six drachms. The solution is introduced hot, and is kept in the front urethra by pressing the lips of the meatus together as the point of the bulb is withdrawn. An applicator is then tightly wrapped with absorbent cotton and dipped in a 10-per-cent. solu tion of argonin and introduced into the urethra as the argonin solution is lowed to flow out. The cotton swab is applied gently to all parts of the an terior urethra for two or three inches and then withdrawn. The operation is repeated, but the applicator is not used the second time if the patient complains of much pain. Pollen Cabot, Jr. (Phila. Med. Jour., Jan. 26, 1901).
Decinormal salt solutions in gonor rhcea accidentally discovered to cause the discharge and other symptoms of the disease to cease at once. Since then the salt solution has been personally employed in all cases and very good re sults reached. The indication is simply to cleanse the urethra with a hot and non-irritating fluid as often as possible: i.e., at least every hour, though inter vals of two to three hours may be ad missible. In PS eases, the average time of cure was 12 V, days; about 30 per cent. lasts 7 clays; 30 per cent., 11 clays; 20 per cent., 17 days; 10 per cent., 20 days; and 10 per cent., over 3 weeks. The actual duration of the symptoms was less than this, C. E. Woodruff (Merck's Archives, July, 1901).