GLEET.
In very chronic cases of gonorrhoea the ordinary internal antigonor rhceal remedies are worthless; the condition is liable to become intract able, the patient becoming hypochondriacal or neurasthenic.
His physical condition should he improved in every way possible, and complications such as constipation, anxmia, dyspepsia and oxaluria should be corrected by appropriate remedies. Stimulants, excessive smoking, sexual intercourse, and over-eating should be forbidden. Exces sive fatigue is as injurious as spending too much time in bed. Sea bathing, when the season permits, or cold baths indoors, and moderate open-air exercise are beneficial in all cases.
Tonics, consisting of full doses of Tincture of Iron (is mins.), with 3 grs. of Quinine or teaspoonful doses of Easton's Syrup, often do good.
The local treatment of gleet is by far the most important, and the number of remedies is almost endless. Every known astringent and antiseptic has been injected. Where the gonococcus is found in the discharge the organic Silver Salts afford the best treatment, but in the majority of chronic cases the examination of the slight mucoid discharge gives negative results. In all neglected cases it is well to begin with irrigation by a r in 2,000 Permanganate solution.
The best routine treatment to start with is the passage of a solid metallic bougie with a wide curve in order gently to stretch the urethral tissue. Thompson's old-fashioned tapering, solid, heavy bougies are, in the writer's opinion, the best instruments for general use. One of them, well lubricated, should be permitted to glide into the bladder by its own weight. The size selected should be of the full diameter of the urethra; it should be left in situ for a period of a few minutes at first, and this period should be gradually lengthened at subsequent sittings and a larger instrument employed each time till No. r 5 (English) is reached. Any lubricant may be used; the writer uses the B.P. Glycerin of Borax. Many cases of gleet will be found to yield to this treatment if carried out for some weeks. Twice a week will be about the best rule for guidance as regards the frequency of the sittings.
The advantage of this treatment lies in its freedom from danger when contrasted with the injections of strong astringent solutions, and it effectually remedies any stricture or narrowing of the urethra which is found so frequently associated with gleet, and it will prevent a stricture forming afterwards.
Any antiseptic may be smeared upon the bougie if made into a stiff ointment. Special grooved instruments are made for the application of solid ointments, but these are unnecessary as, owing to the adhesive nature of lanoline, any substance incorporated with it will adhere to the curve of the bougie, and may be carried down and left in contact with the diseased area. Iodoforrn (30 grs.), mixed with r oz. ointment of Hazeline, is a valuable lubricant. Carbolic Acid, Resorcin, or Nitrate of Silver (5 grs. to r oz.) may be used in this way.
The drug may be incorporated with a firmer basis, and made into bougies, which can be passed down the urethra and left to melt by the heat of the body. Unna's bougies contain (r in ioo) Nitrate of Silver, and are made with cacao butter and a little wax and Peruvian balsam. Antrophores are specially prepared boogies of Thallin Sulphate (2 to 6 per cent.).
The endoscope should he passed after cocainisation when the disease fails to respond to the use of these remedies, and the urethra examined for its entire extent. Any local lesion that is detected can then be directly treated by the application of a strong solution (5 per cent. Nitrate of Silver) to the affected spot.
Guyon's method of instillation of the posterior urethra is often highly efficacious; a soft rubber catheter being introduced as far as the apex of the prostate, a syringe is attached and 15 to 3o mins. of the fluid slowly injected into the prostatic portion of the urethra. The best solution is one of Nitrate of Silver, which at first should be employed in the strength of per cent. This may gradually be increased to 2 per cent. as long as pain and smarting are not induced. Strong solutions at first only increase the mischief, but 5 per cent. Copper Sulphate, gr. Permanganate of Potash to each ounce may he employed when the silver salt is not well borne. The prostate should he massaged from the rectum in order to clear out the secretion from the follicles before instilling.