Liquor. Potassa 3iij.
-11ucilag. Gum. Acacia 7,j.
,Ftheris Nit. 3iij.
Aqua Cinnamomi ad 5-viij. .1.Iisce.
Ft. mist. Capiat Sss. ter in die, p.p.a., post cibos.
Copaiba is apt to produce a profuse rash almost identical with measles; it declines rapidly on withdrawal of the drug. Cubeb powder may be given in wafer paper or in milk.
Local Treatment is of more importance than the constitutional, and is the sole routine employed by many surgeons. Two distinct methods are employed—irrigation and hand syringing. Irrigation of the anterior urethra is carried out by using a 3-pint reservoir with 8 feet of rubber tubing, to the end of which a suitable urethral nozzle is fitted. The fluid is permitted to flow into the urethra by elevating the reservoir about 5 feet. The meatus is compressed and allowed to relax in rapid rhythm, so as to balloon the urethra and overfill it, after which the fluid is permitted to flow out by the side of the nozzle. As a rule the force of the compressor urethre muscle will prevent the fluid reaching the posterior urethra, and this may he assured by squeezing the penis in front of the scrotum. A few drops of a I per cent. Cocaine solution may be injected before commencing.
In irrigation of the posterior urethra a rubber catheter should be passed till the bladder is reached, after which the instrument is withdrawn gradually till urine ceases to flow; the fluid is then slowly injected into the prostatic urethra, and passes into the bladder, mixing with the urine; or the method of Janet without catheterisation may he employed as for anterior instillation by overcoming the resistance of the compressor muscle by raising the reservoir to 6 or 8 feet.
There are numerous irrigating fluids in use: the safest and most satis factory is a solution of Permanganate of Potassium, commencing with the strength in an ordinary acute anterior case of 4 gr. to each ounce (about r in 2,000), or 12 grs. to the full of the reservoir, the entire con tents (3 pints) of which may be used at each operation twice a day; the liquid should be heated to 105° F. As the urethra becomes less sensitive the strength can be gradually increased to double the above proportions, or lessened when much pain is present in very acute cases. ro days usually suffice to destroy the gonococcus by this method. The new Silver Salts—Argyrol, Protargol, Albargin, &c.—are used by some surgeons for irrigation, but the permanganate is on the whole preferable; these agents are more suitable for syringing. A good practice in many
cases is to combine both methods, using the silver salts with a syringe and irrigating with the permanganate.
Syringing.—The chief objection to this method of treating gonorrhoea is the danger, especially when a syringe is employed with a blunt nozzle, of the gonococcus being forced backwards into the posterior urethra. With precautions, such as grasping the penis in front of the scrotum and using a fine nozzle, this danger is minimised or prevented. Permanganate may be selected if the case is seen early; the strength of the solution need not at first be more than gr. per oz., which can gradually be increased till double the amount is tolerated. Permanganate of Zinc is much used also, and it can be employed in the same strength. Even in the most acute cases the potassium salt can be injected every hour in warm solution if only i gr. in 5 or ro oz. be employed till the acute irritation subsides.
Silver salts are preferred by some surgeons, especially when the case is not seen till the discharge is well established. In anterior urethritis 4 drs. of a recently prepared solution of i per cent. Protargol, Albargin, Actol, Ichthargon, Argyrol, Collargol, or Argonin may be injected 3 or 4 times a day, the strength being gradually increased and the period during which they are retained in the urethra prolonged for so minutes or more. r per cent. solutions are soon tolerated. Some surgeons commence with irriga tions by permanganate or weak Perchloridc or Mercury solution (s in 2o,000) before employing these salts when the inflammation is very acute. Protargol is the best of the silver salts for ordinary use. At a later stage, when the discharge has been well checked, the period for the use of astringent solutions has arrived, in order to combat the inflammation which the gonococcus has left behind after its destruction has been effected by antiseptics. It is a mistake to start with pure astringent agents in the acute stage with profuse discharge. Zinc Sulphate s gr. tor oz. is the best routine, Acetate and Sulphocarbolate of Zinc, Acetate of Lead and Alum, may all be used of double this strength. Chloride of Zinc tor gr. and Nitrate of Silver to r gr. per oz. are also valuable antiseptics and astringents for use in the late stages.