Otis first dilates gently the urethra to its full extent without using force, then a silk coude catheter is introduced just beyond the compressor urethrie muscle, so that the eye lies in the neck of the bladder, then about S oz. of fluid injection is introduced into the bladder by a syringe. The catheter is then withdrawn, and the patient flushes out the urethra by emptying the bladder voluntarily.
He commences the treatment by using an injection consisting of i part each of Sulphate of Zinc, Alum and Carbolic Acid in 2,000 parts. Upon the second day the water is reduced to r„soo, and upon the third to x,000, and upon the fourth day to Soo parts (r gr. to I oz. nearly). Upon the fifth day solution of Permanganate of Potassium (c in 2,000) is used, upon the sixth r in 1,5oo, upon the seventh r in 1,000. Afterwards the solution is changed to one of Nitrate of Silver (1 in ',coo) gradually increased to in loc. Should the injections fail, a few drops of a 5 per cent. Nitrate of Silver solution are passed into the deep urethra by the drop-syringe, and when the disease still resists he performs internal urethrotomy.
Ionisation methods have their advocates; the urethra being filled with silver nitrate or zinc sulphate solution, the negative pole of a galvanic battery is applied to the spine and the positive to a metal instrument left in the urethra. A weak current is turned on for ,5 to 25 minutes; the
silver or zinc ions, being permitted to penetrate deeply into the diseased tissue, cause practically no pain.
Much benefit may often lie obtained by periodical massage of the prostate through the rectum, and cure has followed the use of the X rays. Suction applied by means of the aspirator and of specially devised pumps has been used to empty the infected glands and ducts. Injection of the prostate with Colloid Silver by a long needle thrust through the ischio rectal space is practised by some surgeons.
Vaccine treatment has been successfully employed in many intractable cases, a vaccine being prepared by using several strains of gonococcus when the coccus cannot be obtained from the patient's discharge. Small doses (i to to millions) frequently repeated are usually sufficient. Where the infection is of mixed nature Polyvalent Antistreptococcus serum has been used.
The different injections which may be employed as a routine in the late stages of gonorrhcea before the above-mentioned methods of treatment are resorted to for an established gleet will be found in the article on Gonorrhoea.