In the treatment of these cases it is usually recommended to cleanse the cer vix and os carefully; swab with bichlo ride-of-mercury solution, 1 to 2000; and then apply silver-nitrate solution, 10 per cent.; zinc-chloride solution, 10 per cent.; copper-sulphate solution, 10 per cent.; or Lugol's solution. A more radical and more efficient treatment is the dilatation and curetting of the cervix after the preliminary cleansing. Such active measures should be undertaken only by those specially equipped by large experience. The danger of a consecutive gonorrhoeal metritis, salpingitis, and peritonitis demands that this disease re ceive the most intelligent treatment. The latter conditions belong rather to the gynmeologist than to the genito urinary specialist.
Chronic latent gonorrheea in the male may set up the same disease in a woman without any acute symptoms either in the vulvar region or higher up in the genital tract. The urinary passages often escape entirely. The vagina itself may escape infection, the endometrium alone being attacked. Pregnancy goes on un impeded, but in the puerperium slight fever is observed and gonococci are found in the discharge. The best injection in these cases is a 1 in 2000 solution of nitrate of silver. Fritsch (Centralb. f. Gyn., No. 31, '97).
Results of treatment in 140 successful cases reported. Solutions of nitrate of silver from 1-1000 to 1-3000 were poured into the vagina through a cylindrical speculum, the cervical canal being swabbed out with the same. In cases of fronorthecal endometritis the uterine cav ity was irrigated with the same solution. Miliajlovits (Amer. Jour. Med. Sei., Jan., '9S).
Protargol found to be the safest and best application in the treatment of gon orrheca, in women, in cases in which the cervical canal, the endometrium, and oc casionally the tubes are involved. The author's method is as follows: (1) the vulva and vagina are cleaned and dis infected; (2) the cervix is gently pulled down, and when necessary the internal os enlarged with dilators; (3) the uterus is washed out with sterile tepid water; (4) then with at least 3 pints of a solution; next, if this produces no irritation, with (3) a 1-per-cent. solution; (6) the vagina is dried with sterile cotton-wool, and a 5 per-cent.-protargol bougie passed into the cervical canal, and kept in place with a tampon; (7) after fifteen minutes, when the bougie will have melted, the tampon is removed, the vagina dried with wool, and a 10-per-cent-protargol-glyeerin tam pon introduced; (S) after twenty-four hours the same process is repeated, and every day for five to seven days, only the protargol solution is strengthened grad ually to 2 per cent., and the bougies to 10 per cent. The woman should keep In
bed for the first week of treatment; (9) although at the end of this time no gon ococei can he found, it is necessary to repeat the process every other day dur ing the second week; on the alternate.
day astringent solution (2 bismuth subnitrat c with glycerin and water) and bougies of boro-phenol-alum 1 per cent. are used, though the tampon is still of protargol glycerin; (10) dur ing the third week astringents alone are employed (a daily injection of the bis muth with one alum bongie and tampons of glycerin of tannin); (11) cure is com pleted in three weeks, but it is well for the woman to continue the injections herself for a time. Furst (Then Monats., Apr., '98).
Local treatment should always be in stituted, consisting of irrigation of the urethra with protargol '1,-per-cent. solu tion increased to 1 per cent. This is preferably accomplished by Skene's re flux catheter or a soft-rubber catheter. At the same time internally a capsule containing balsam of copaiba and oil of sandal-wood is administered. When the nrethritis persists and tends to become chronic, astringent applications of zinc and alum are repeatedly made to the urethral tract. The diagnosis of cervical gonorrhcca can only be made by the microscope, as the clinical symptoms are not pronounced. The best treatment consists in the injection into the cervi cal canal of solutions of 1- and 2-per cent. protargol. The syringe used for this purpose resembles the deep urethral syringe of the male, but has no curve. The treatments should be made every other day at the least. Small (Univ. of Penna. Medical Bulletin, July, 1902).
Stricture of the Urethra.
The urethra, except during the pas sage of urine, of semen, or of an instru ment, is in a collapsed condition. Under normal conditions it is dilatable to a cer tain calibre, depending upon the circum ference of the flaccid penis. Any con dition which interferes with this nor mal dilatability is called a stricture. The common causes that give rise to symptoms of stricture are: 1. Intlam matory changes such as accompany acute urethritis. This condition is temporary and subsides under appropriate treat went. 2. Muscular spasm, usually of the compressor urethra?, and due to the irri tation caused by an acute urethritis or an erosion of the urethra either alone or existing behind a stricture, or more rarely to reflex irritation from haemor rhoids, anal fissure, etc. 3. The organ ization and contraction of lymph follow ing gonorrhcea or other form of injury to the urethra. The latter is called "or ganic," or "true," stricture. Congenital stricture of the urethra is so rare as to be a curiosity. The diagnosis and treat ment are, however, similar to organic stricture.