In the great majority of cases of gonorrhoea six to eight weeks should sec the disease entirely subdued, and often under judicious treatment in half this time the patient is convalescent. If doubtful of the result of cure the surgeon may inject a r per cent. nitrate of silver solution into the urethra to provoke a mild urethritis, and examine carefully this discharge for gonococci, or if the convalescent patient returns to the use of alcohol (beer or wines especially), and notices that the discharge reappears, lie must submit to further treatment. Chronic posterior yield speedily to N-ray treatment. The highly infectious nature of the gonor rhceal discharge must be explained to every patient, and he must be warned of the danger of transferring the gonococcus to his eye by soiled fingers or towels. Marriage must be forbidden as long as any trace of discharge is present, and as the gonococcus may remain dormant in the urethral glands for many months, a two years' interval will he neces sary as a safe precaution in all instances.
Magian's rapid method of cure is often effective. Ile commences by giving a 3-gallon irrigation of r in 5,000 Pot. Perming., sufficient elevation being used to drive the injection up to the neck of the bladder by a two way irrigation tube. Ile then irrigates under high pressure by 3 gals. distilled water followed by the same amount of fluid containing r oz. Protargol. 3o grs. Chloride of Gold in 40 oz. water is next injected under pressure, using a single-way irrigator nozzle, and after an interval irriga tion by distilled water follows this. The patient is then sent home to use a per cent. injection of Protargol 8 to io times during the next 24 hours, and to take an Allosan (Allosan is the allophonic ester of santalol) tablet every 3 hours. At bed-time a 6 inch Neisser bungle containing 1 per cent. Protargol and 2 per cent. Antipyrine is tied in.
The above-mentioned irrigations arc repeated in increasing strength on the second, third and fourth days. On the fifth day he uses 3 gals. weak Zinc Sulphate and on the sixth a similar amount of weak Silver Nitrate, after which the cure is almost invariably complete.
Vaccine treatment has many advocates; upon the whole evidence seems to be in favour of reserving this for cases with complications, and it does not seem to be certain that an autogenous vaccine is better than one contain ing meningncocci or colon bacilli. A stock vaccine of 5o million gonococci and 15o million staphylococci may be employed in acute uncomplicated cases. Recently Harrison and Thomson at Rochester Row Military Hospital have used detoxicated vaccines, and have given figures which seem to indicate that vaccines so used will be really useful in the local manifestations of the disease as opposed to the complications. The
complications of gonorrhoea in the male are numerous, and as these will be dealt with under the headings of Conjunctivitis, Orchitis, Bladder Inflam mation, Rheumatism, &c., only a brief reference is here necessary.
Pain in micturition may be relieved by immersing the penis in very warm water or by passing urine when sitting in the hot Sitz-bath. Painful erections or Chordee should be met by a full dose of Camphor Monobromate (ro grs.) in cachet or by a large warm-water enema, followed by a supposi tory as under, or Cocaine may be injected.
Sleep may be induced by large doses of Bromides (6o to 90 grs.), with io grs. Chloral, when morphia is contra-indicated.
It Morph. Hydroc'hlor. gr. z.
Ext. Bellationme Fir. gr. j.
Pulv. Camphorre gr. y.
Olei Theobrom. ad gr. xv. Misce.
Fiat suppositorimu. i. atelli111111 h.s.
Balanitis is liable to supervene when the foreskin is long. It should be met by freely syringing the prepuce with warm Boric Acid solution and absolute cleanliness.
Inflammation of Cowper's glands sometimes ends in suppuration. It is wiser not to wait for the chance of the pus finding its way into the urethra, but to make a free perineal incision to avoid the danger of a urinary fistula.
Peri-urethral abscess about the fossa navicularis may be left to open into the urethra, but when surrounding the penile portion of the canal it should be incised from without.
Buboes should be treated by absolute rest and warm fomentations or Boric Acid poultices, and incised as soon as matter forms. They arc probably always due to a mixed infection.
Epididymitis is usually regarded as an indication for the suspension of all injections, but the writer finds that very warm and weak Perman ganate injections cause no increase in the inflammation of the gland, and may even afford some-relief. All other solutions should be prohibited. Absolute rest with the support of the testicles on a shelf or by a suspensory bandage and the application of Ichthyol, Belladonna, &c., are necessary. The further treatment by leeching, incisions, tapping, &c., will be dis cussed under Orchitis.
Gonorrhoeal rheumatism is a serious sequela, and, like gleet, septicmmic or pymmic conditions and many other sequelm, is being now treated by Vaccination and Serum Therapy, as will be described under its owr heading.