Some cares of gonorrhoea are capable of being treated in the very early stages by an abortive method. The indications for such a treatment are that the dis charge must not have been present for longer than three days; that it is not already of a thick, purulent nature; a ml that the urethral mucous membrane is not tender when water is being passed. The cases which are especially suited are those in which the discharge is of a serous nature wit I: only a trace or pus; in it; when examined by the microscope, only a few gonococci are to be found, and these are principally placed extracellidarly. At first, the writer carried the treatment out with solutions of silver nitrate, a ml all hough fairly good results were obtained with it, other preparations have since been Found to be bitter adapted. A 2-per c•nt. solo( ion of AgNO,, was used, \Odell was allowed to remain in the urethra for from 20 to 30 seconds. after which the canal was washed out with water. On the following day a 2-per-cent. solu tion was used and this strength con tinned during the rest of the treatment. The stronger injections were but little painful, but on the next morning the patients usually complained of consider able pain. The preparations which have given better results are protargol, al bargin, and another silver body, a com bination of the metal and gelatose. which is not vet on the market. The protargol was used in a 4-per-cent. solu tion, and the albargin in 1- and 2-per rent. solutions. Neither appeared to irritate the urethral mucosa at all, and it was left in the urethra as long as from three to five minutes. and the strength of the solutions was not less ened on the second clay of treatment. This abortive treatment has been suc cessful in curing 40 per cent. of personal cases, but the injections should not be discontinued as soon as the discharge has ceased; usually this occurs after the second day, but it will be found on careful examination that there are still some pus-cells in the urine, which dis appear on the fourth or fifth day. The injections should be continued for a few days longer. In those cases in which the treatment proves of no avail, no harm is done by the attempt to shorten the attack. In recommending this pro cedure the author admits that he is not advocating anything new, hut merely suggesting a new adaptation of an old method. The progress of every case of gunorrlima should be gauged by regular microscopieal examinations of the dis eliarge. A. Blaschke (Berliner klin. Wochen., 'May 12, 1902).
If either of these has been tried and has failed, the following routine treat ment should be carried out: Treatment.—In the most severe cases with a high grade of inflammation, pro fuse discharge, ardor mina;, and chordee, it is very desirable to have the patient go to bed, or at least to be as quiet as possible. A light diet should be ordered, consisting largely of milk, with bread, potatoes, well-boiled rice, and such plain farinaceous foods. Water should be drunk freely. The bowels should be kept rather free with small doses of some saline laxative, repeated as often as necessary to secure the desired result. The use of alcohol should be forbidden. Sexual excitement is harmful, and coitus is to be positively forbidden, both on ac count of the contagious nature of the discharge and the injurious effect on the disease. The urethral discharge should be received on a small piece of absorbent cotton held in place by a gonorrhoea apron, or similar device, and the glans and prepuce bathed frequently with soap and warm water for the purpose of cleanliness and also to avoid bal anoposthitis. The most rigid caution
must be observed in disposing of the soiled cotton, towels, and all other ar ticles contaminated with the discharge, and the hands should be most carefully washed after each dressing, as gonor rhceal pus, if transferred to the eye in any manner, excites a most violent in flammation which requires the most con stant and active treatment for weeks and may even result in the loss of the eye.
Gonorrhoea is a local disease, and must be treated largely locally. Internal rem edies are of use, however: (1) to render the urine neutral or faintly alkaline, and hence less irritating; (2) to increase the flow of urine; and (3) to allay irri tation of the urinary tract by such drugs as are sedative to mucous membranes and are excreted by the urine. Liquor potassic meets the first indication. It may be given in doses of 10 minims, freely diluted in water four to six times a day. Potassium citrate fills both the first and second indications. The dose is 20 grains in half a glass of water every two to four hours. With either of these may be combined sweet spirit of nitre if there is fever, and potassium bromide to lessen the excitability of the nervous system. The third indication for inter nal treatment cannot well be met when the urethritis is very acute, as cubebs, copaiba, and sandal-wood seem to exert a more favorable influence on the sub acute and chronic cases. When the se verity of the inflammatory symptoms has passed off, however, one of these may be administered with advantage. A bination which has been very satisfactory in a large number of cases is the "corn pound-salol capsule" originated by Dr.
White a few years ago. Each capsule contains: salol, 5 grains; oleoresin of cubebs, 5 grains; Para balsam of co paiba, 10 grains: and pepsin, 1 grain. Four to G of these are to be given daily after meals. Capsules of either the cubebs or copaiba or the two in combi nation may be given and in the more chronic stages the oil of sandal-wood, 10 to 20 minims after each meal, is efficient.
Nine cases of acute gonorrhoea in the male have been treated by the internal administration of methylene-blue. All cases were first attacks. Two cases were seen four and five weeks, respectively, after the discharge had ceased. and no recurrence had then taken place. In one of these cases the discharge ceased in twelve days and in the other in sixteen days. The methylene-blue is excreted unchanged in the urine. The dose given was 3 grains three times a day. J. Moore (Brit. Med. Jour., p. 140, '97).
Methylene-blue administered internally will cure gonorrhma in from four to seven days. To the diplococeus, which is the specific cause of this disease, it is especially fatal. The pyogenic bacteria that make rranorrhcca a mixed infection succumb very promptly to this germicide.
It is best given in gelatin capsules in 1-grain doses three or four times a day. After the fourth day the dose may be reduced to twice a day. Given alone it sometimes causes irritation of the neck of the bladder, but when combined with oil of nutmeg there is no trouble of this kind. J. Alan O'Neill (Med. Record, Mar. 24, 1900).