Locally cleanliness secured by fre quent bathing and suitable means to re ceive the discharge are very desirable. Rubber covers and bulky dressings that retain the secretions and macerate the parts are objectionable. If urination is accompanied by severe pain, great relief will be secured by immersing the penis in a vessel of water as hot as can be borne comfortably during the act of pass ing the water.
Urethral injections or irrigations may be employed from the beginning of the disease. Certain points must be kept in mind in this connection: 1. Nothing is to be introduced into the urethra until it has been cleansed by passing urine. 2. The solutions used in the early stages must be exceedingly mild unless abortive treatment is at tempted. 3. In the beginning the injec tion is confined to the first inch or two of the urethra. In high grades of in flammation the solutions should be slightly alkaline, and if used as warm as can be borne will give greater relief. It may be stated positively that any appli cation that causes severe or prolonged pain or smarting is harmful, as the re sistance of the tissues is thus lessened and further extension of the infection is favored in consequence. In an acute case the injection may be of potassium permanganate, 1-10,000 to 1-5000 in normal salt solution, as in the following formula:— Potassii permangan.,V., to 1 grain. Sodii chloridi, drachm.
Aquze destillatie, 11 fluidounces.
N. Sig.: Use four to six times daily, as directed.
A similar solution is also employed to "irrigate" the urethra. To a pint of dis tilled water may be added from to grains of potassium permanganate and 45 grains of sodium chloride, the solution warmed, and placed in a fount ain-syringe to which a urethral nozzle is attached by rubber tubing. The reser voir should be two feet above the pubes. Urine having first been passed, the solu tion is allowed to run, and the nozzle fixed firmly in the meatus. As soon as the anterior urethra is distended the nozzle should be removed and the ure thra allowed to empty itself. This is re peated until the pint of solution is all used.
In acute gonorrhoea the following is recommended: Plenty of natural spring waters, which produce the best diuretic and cathartic effects. Permanganate of potassium in hot aqueous solution 4 grains in 1 pint as a urethral injection used three times daily for a week. At
t he end of this time the following:— R, Bismuth subgallat., I drachm. Zinci sulphatis, 18 grains. Aquee calcis, 6 ounces.
M. Sig.: To be used as an injection thrice daily after urination. John L. Howard (N. C. Med. Jour., Mar., '98).
Irrigations with permanganate of po tassium are as efficient as those with argonin and protargol, and possess the merit of being extremely cheap. Nieber gall (Dent. Milit. Zeits., No. 6, '98).
Protargol, the new silver proteid com pound, has been personally given a care ful trial in 40 cases of acute gonorrhoea, most of them being seen during the first week of the infection, and none of them having been previously subjected to other treatment. From these cases it is decided that protargol is a very efficient anti gonorrlimal remedy, which, if employed at an early period, exerts prompt and favorable influence upon the course of the disease, in the majority of cases, ar resting all acute manifestations, causing rapid disappearance of the secretion and gonococci, preventing extension of the process to the posterior urethra, and usu ally giving good results even in fully developed eases of anterior and posterior urethritis. The injection of protargol of 1 per cent. to 1 per cent.) should be kept up for a number of weeks, after which astringents 1,11ould be resorted to in order to prevent recurrence. E. Finger (Times and Register, June 11, '98).
In acute gonorrhoea a smear of the discharge is made, if possible, on a cover-glass in order to confirm the diagnosis. This having been established, a 1-per-cent. solution of protargol is prescribed which is to be used slightly warm, in a '1,-ounce blunt-pointed rub ber syringe, three or four times daily. The patient is directed to urinate before the injection, and then to grasp the glans penis and raise it perpendicularly, put ting it slightly on the stretch, but not to put a finger on the perineum to prevent the fluid from going back into the blad der. The fluid should be retained in the urethra five minutes, the patient gently stripping it backward with the finger while holding the meatus closed. Any slight smarting complained of by the pa tient will appear only during the first two or three injections, and then only temporarily.