GONORRHOEA.
Abortive treatment can only be considered as possible when the patient is seen within 48 hours after the appearance of the first symptoms of the disease--i.e., within a week after the infective coitus, or earlier. At this stage there is slight scalding or itching about the meatus, and a faint sticky but not obviously purulent discharge. Several plans are recom mended: the simplest is to inject into the urethra a weak Cocaine solution after grasping the penis in front of the scrotum in order to insure that the gonococci will not he washed backwards into the posterior urethra. In five minutes afterwards 4 drs. of a solution of to grs. tor oz. Nitrate of Silver, or a is per cent. Protargol solution, should be injected after firmly grasping the penis for 2 or 3 inches beyond the meatus, after which the patient should lie up in bed for a day or two, and the operation repeated once on the third day. Another plan which is less irritatin? and equally efficacious is to thoroughly irrigate the anterior urethra by a gr. tor oz. Hot Permanganate of Potassium solution, repeating the operation several times at intervals of 12 hours, the urethra being blocked by an elastic ligature or by the pressure of the finger and thumb in front of the scrotum. It is needless to say that these procedures must be carried out by the surgeon, and never entrusted to the patient. The plan of introducing the urcthroscope and directly applying Protargol, Nitrate of Silver or Perchloride of Mercury solutions is painful and not more efficacious.
For the established disease with its profuse purulent discharge the patient should be advised to take to bed when possible. A smart Saline Purge should be administered and the testicles supported by a suspensory bandage. The diet should be as fluid as possible, diluent drinks being freely administered in order to thoroughly flush out the urethra by frequent micturitions. Milk diet answers this purpose admirably; tea, coffee and alcohol should be forbidden. If the patient is a smoker there is no objection to his mild indulgence in tobacco. A simple diuretic
mixture should be given every 2 or 3 hours; Salicylate of Soda in Camphor water with Mindererus spirit is a good routine in all severe cases.
When there is much smarting in passing water Alkalies may be freely administered, or an effervescing mixture consisting of i dr. Bicarbonate of Potash in 2 oz. water may be prescribed, with oz. fresh lemon-juice, and Barley water given between each dose in copious draughts.
Drugs intended to disinfect the urethra on their elimination by the urine should not be administered in the very acute stage; the proper period for their exhibition is when the profuse discharge begins to show signs of diminishing. Santa] Oil, ('opaiba and Cubebs are the most reliable; they arc much less used than formerly, since the disease is now treated for the most part locally. Nevertheless these drugs are of great value in practice where the patient cannot be relied upon to use injections skilfully, and where irrigation of the urethra by the surgeon is not avail able; in intractable cases theyafford a valuable addition to local treatment.
Oil of Sandal Wood is the least irritating of these, and as a rule its administration may be commenced earlier than that of copaiba; it should be given in 15-min. capsules 3 times a day. Santalol or Atheol, which is the active ingredient of the oil, may be given in 5-min. capsules. A number of allied substances as Santvl, Camphosan, Thyresol and Aflosan, are in use. Copaiba in 15-min. capsules is more reliable,.but the stomach is very liable to be upset with it, and the eructations are most annoying after full doses.
For hospital patients this drug may be advantageously administered in combination with Cubebs as a confection— It. Pulv. Cubebev Pulv. Polassii Nit. 5ij. Pulv. Doveri Zss.
01. Sandal.
Beds. Copalluv q.s. ut fiat electuarium durum.
Sigma.--" The size of a hazel-nut to be taken in wafer taper, three times a day, two hours after meals." The following mixture is an old but rather disgusting combination— Bats. Copaiba 5vj.