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Appreciating the fact that from fifty to seventy-five per cent. of the acute inflammatory conditions of the female pelvis are due to gonorrheal infection, that gonorrhea in the male is as deceptive as Satan, and frequently a very troublesome disease to cure, makes the above question, to the thoughtful and conscientious physician, one of serious import.

When we consider this high percentage of innocent women suffering as a result of man's ignorance and depravity, and knowing that ninety or ninety-five per cent. of the male population at some period of their lives suffer from gonorrhea, this question can not too often be brought before medical men for discussion. Patients are so frequently seen with a chronic gonorrhea, which has extended over a period of years, that the question is often asked, is the disease curable? When the infection is confined to the genital organs, that is, the urethra, bladder, prostate, vesicles and adjacent glandular structures, it is curable at any stage. When the kidneys or the joints and other serous membranes are attacked, it is doubtful if they are ever restored to their normal condition. I warrant the assertion, and can demonstrate it, that in a large majority of the chronic or relapsing cases of gonorrhea the seat of trouble, or focus of infection, is in the prostate gland and seminal vesicles. Next in frequency, it will be found in the thickened and inflammatory tissues around

urethral strictures or fistulous tracts and periurethral glands.

In a case of gonorrhea that has extended over a period of months the gonococcus has not limited its ravages to the epithelial covering of the urethra, which an ordinary injection or local application will reach, but has penetrated deeper into the tissues and, therefore, more stubbornly resists therapeutic measures. It is not infrequent to see a patient who has gone for months without any external evidence of the disease, and the urine containing very few "clap shreds" develop, as it were, a fresh attack from the passage of a full-size sound; or thorough massage of the prostate will bring to the surface gonoccocci that have been lying dormant in the glands and follicles. The poin: which I wish to emphasize is that the disappearance of all external evidence of the disease, as a rule, leads the patient, and too frequently his physician, to believe that he is well, when, in fact, he is as dangerous from the standpoint of being infectious as if he had a purulent discharge from the urethra. It is not only the genito-urinary surgeon who should be posted in regard to these matters, but every physician who takes charge of a case of gonorrhea should be well enough informed to make the necessary examination and tests, and determine whether a man can infect his wife or not.

The urine of a gonorrheal patient should be examined each day in a clean, clear glass, with a good light, to see if shreds or particles of pus are in the specimen, and to note the improvement or retrograde action of the disease. This test is as important as taking the pulse of a patient with an acute febrile disease. There may be pus in a patient's urine and gonococci absent, but it is the exception, when there is a history of gonorrhea. It is the duty of a physician, before dismissing a patient as cured, to see

that his urine is free of pus, or, if pus is present,' that it does not contain gonococci; that the prostate or seminal vesicles are not involved; that there are no fistulous tracts cr enlarged glands about the frenum or along the urethra; he should pass a bulbous bougie or urethrometer to note if there are contractions of the urethra. With the endoscope the entire length of the urethra can be inspected to determine if any of the follicles or crypts are diseased.

To treat gonorrhea scientifically it is absolutely necessary to use the microscope. It is criminal to write prescriptions for patients, allow them to treat their own case, and, with the little knowledge they have of the disease, determine from external appearances when they are well.

If every practitioner will make it a rule to carefully examine the genitals of this class of patient, feel of the prostate to ascertain if it is sensitive, hard, enlarged or involved in any manner, strip the vesicles, and examine the various secretions under the microscope, which is a simple procedure, it will take only a short time to gain the experience which every man should have who handles cases of this kind; then he can give to his patrons the scientific advice they pay for, and to humanity that which he owes. When a patient's urine is free of pus; when the prostate and vesicles are in a normal condition, when the periurethral glands are not enlarged, when the prostatic and seminal secretion obtained by compression and urethral discharge set up by a solution of silver nitrate does not show the gonococcus present, we can state to a gonorrheal patient that he may safely marry. The highest and most unselfish duty in our professional work is the prevention of disease and the protection of the innocent. We can in part perform this duty by protecting innocent women from the ravages of this dread disease, and lessening the number of infants soon blind to the world.



I wish first to report a very interesting case of gonorrhea. May 24, 1905, a negro whose features and personal demeanor were characteristically African, came into my office and said: "Doctor, I want you to do something for my eyes." A severe conjunctivitis of one eye was evident. The history revealed a mild case of gonorrheal urethritis. A microscopic examination of the excretions from the eye made by my brother and myself demonstrated the presence of the gonococci in abundance. He was instructed as to diet, cleanliness, temperance and hygiene. A mild solution of protargol was prescribed and I asked him to return in five or six days, as he lived about eight miles. June 2d he returned somewhat improved. The prescription was refilled and he was instructed to return when he had used the medicine. He was next seen July 19th. Was he cured? Nay, verily. Both eyes were affected and wo corneal ulcers in each eye. Both nasal chambers were typically gonorrheal. A tonic treatment was given. Peroxide of hydrogen, followed by protargol solution was the prescription to be used in the eyes and nasal cavities. Ulcers were treated locally. He was asked to come more regularly, which he did for six or eight weeks, at the end of which time he was very much improved, or about well. Subsequently he removed and has

not been seen since.

This was a case of gonorrheal ophthalmia of pro(377)

25 mt

nounced severity, originating from a mild case of gonorrheal urethritis that yielded to treatment. Is it not probable that the infection went from the eye to nasal cavities by way of the nasal duct? Both sides were affected simultaneously and were equal in severity. In treating gonorrheal urethritis I have found for the initial of the attack a 5 to 10 per cent. solution of protargol one of the best remedies to use as injection three times a day or more, at the same time giving some of the mild urinary antiseptics. For attack of long standing pass your sounds for a stricture of some type, for it is more than likely to be present. I have been more successful with permanganate of potash as an injection, varying in strength according to the individuality of the case. Here, too, I consider the internal antiseptics of service. That gonorrhea is due to the gonococcus no informed physician will dispute. It is equally well known that gonorrhea is contracted nine hundred and ninety-nine cases out of a thousand by sexual intercourse. In every case, one for sure, and sometimes both, of the parties are prostitutes. G. Frank Lydston, than whom we have no better authority on genito-urinary surgery, says that "the fallacious notion of the simplicity of gonorrhea and its congener has proved disastrous. Physicians should embrace every opportunity to impress the patient with the fact that gonorrhea is one of the most, and perhaps the most, far-reaching in its results of all the infectious diseases. It is not only worse than a bad cold, contrary to the lay opinion upon the subject, but it is far worse than its much dreaded rival for venereal popularity syphilis."

In view of these facts we have not discharged our duty to our patients if we fail to impress on them the gravity of the disease, and the absolute necessity of their most hearty and sincere co-operation in treating gonorrhea. Again we

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