Richard's injection consisted of 5 grs. Sulphate of Zinc and 5 grs. Acetate of Lead per oz. Berkley Hill employed an injection in the late stages, which consisted of a number of the above combined—zinc sulphate 35 grs., alum 35 grs., sulphate of iron 20 grs., sulphate of copper 2 grs. in 8 oz. water—but this should only be used when the disease is of several weeks' standing.
Ultzmann's injection as modified by Guiteras consists of grs. each sulphate of zinc, alum and carbolic acid with r oz. glycerin and 7 oz. water. In the chronic stage of anterior urethritis passing into gleet all the above except Hill's injection may be safely employed in double the strength mentioned.
In gonorrhoea of the anterior portion of the urethra the patient should always he directed to flush out the canal by passing urine before injecting. The solution should he used warm. A convenient plan is to carry a small wide-mouthed bottleful of the injection in the trouser pocket, which soon reaches a comfortable temperature. It is much better to use a weak solution very often than a strong one less frequently. The liquid should be retained each time by compressing the meatus for a few minutes, and for all purposes the permanganate of potassium solution is the safest and least irritating, but it must be always remembered that the irritation and a slight mucous discharge may remain after the disease is cured, being kept up by continual syringing.
The successful treatment of gonorrhoea by injections depends, upon the whole, much less upon the nature of the injection than upon skill in prescribing it. The writer, therefore, ventures to suggest to the young practitioner the advisability of selecting one drug and adhering to it persistently, varying its strength and altering the frequency of the injec tions according to the effect desired or produced. By these means he soon becomes master of the remedy, and he will be astonished to find how much he will be able to do with it, and how easily he can alter its effects to suit the constantly changing conditions of the diseased state. The endless varieties of injections tempt the physician to change from one to the other, to the detriment of the patient and to the deterioration of his own experi ence. This principle applies to every department of treatment, and is one of the secrets of the success of those physicians whose conservative prejudices have prevented them from trying most of the new and often worthless drugs daily written up in the current literature of medicine.
Little need be said of the method of treating gonorrhoea by antrophores or bougies made of Thallin, Iodoform, &c., incorporated with a firm, easily
melted basis; they are more suitable for Gleet (which see). Klapp's suction bell is employed by some surgeons, and Thomson and Miles state that by applying it to the penis for io minutes and reapplying it after an interval of 5 minutes during an hour's duration daily for so to 14 days the disease may be satisfactorily dealt with in recent cases without resorting to other measures.
In acute posterior 2trethritis the urgent symptoms should be first met by a hot Sitz-bath and a saline purgative, followed by a suppository of Morphia gr. with s gr. Extract of Belladonna and Urotropin internally. (r) The irrigation method (Janet's) already described may be carried out by elevating the reservoir to the height of 6 or S feet to overcome the action of the compressor urethra: muscle. (2) Didav's plan of introducing a catheter to the prostatic portion of the urethra and injecting the liquid into this portion of the canal, from which it flows into the bladder, which should always contain urine, before commencing the operation. The Permanganate of Potassium solution is the most easily managed; it should be injected warm and at first not stronger than r in 5,o00. Protargol may be used much stronger, commencing with I per cent., which may be doubled after a few irrigations. Nitrate of Silver is much more painful, and if used should not exceed s in 500 ors in r,000. (3) There remains Guyon's method of instillation. This is carried out by injecting with an Ultzmann's syringe 15 mins. of a r per cent. Nitrate of Silver solution through a soft catheter, whose eye is lodged in the prostatic portion of the urethra. Every second day is sufficient for the instillations. which may be stopped when the urine collected at the end of micturition is found to be clear. The best procedure is to irrigate first with permanganate and reserve instillation for cases where this fails. The instillation treatment of posterior urethritis practically becomes the treatment suitable for gleet or chronic posteriorurethritis,sincc the acute stage is often allowed to pass off under palliatives bathing, suppositories, &c.; under these circum stances stronger solutions may he employed, as described under Gleet. When the glect stage is approached in case of chronic anterior urethritis, hand syringing with Silver Salts or the astringent agents mentioned upon a previous page arc to he persevered with, the strength of the solution being increased to 2 or 3 times that usually employed for the treatment of the acute disease.