I have been pleased with the treatment of this disease in the acute form, in the male, by a very simple method, and so uniformly successful is that method, that although I have on other occasions presented it to my readers, I take pleasure in writing more fully the details of the treatment, in perhaps a more specific manner.
In the first place, with the development of fever and a high degree of nervous excitement, accompanied with a profuse urethral discharge at the onset of the disease, I give full doses of gelsemium, three or four drops, and two drops of macrotys every hour or two. It is seldom that I give aconite for the fever. These two remedies combined control that manifestation in a satisfactory manner. The parts may be bathed in tepid or cold water, and the organs should be supported by an ordinary support and the patient should lie very quiet and abstain from solid food.
I also, for four or five days, rigidly exclude alcoholics and tobacco. I have cured many cases with this simple method alone, but it is not all sufficient for most of them. There is a thick, creamy discharge that contains pus cells in large quantities. With most of the cases there is pain and a frequent tendency to urinate, and chordee.
Gelsemium is the indicated remedy for these symptoms, but I am very favorable to the use of irrigation with which to cleanse the urethral canal. I first use warm, sterilized water in a small catheter, permitting the excess of the fluid to return from the urethra around the catheter. This it will readily do if care be taken in the selection of the catheter.
On some occasions it is a good plan to introduce the catheter while the irrigating fluid is flowing, inserting the catheter slowly into the canal until it has reached the full length of the urethra without entering the bladder.
When the irrigating fluid returns perfectly clear, I use a very mild solution of permanganate of potash, perhaps 1 to 5000. This is inserted slowly, the irrigating fluid flowing from the catheter as it is inserted and continuing to flow the entire length of the canal. This should be introduced as warm as the patient can stand it and should in no way precipitate before it is introduced.
It is not a bad plan to use sterile water again after this is used until the water runs clear. A very thorough irrigation should be used for the first three days, perhaps once every day; subsequently not oftener than once in three days, or it may be discontinued entirely.
The success depends upon the thoroughness of this irrigation. If local engorgement is severe and there is some degree of persistent, nervous excitement, with the internal medicine advised I would give, at bedtime, fifteen grains of sodium bromid and fifteen minims of fluid extract of ergot, for one or two nights.
If there are sharp, shooting pains on the passage of water, I would give hydrangea in full doses with the first named mixture. If, after the first five or six days, there is a slight discharge present, I would then give with the gelsemium and macrotys, kavakava. Where a number of weeks have gone by and still there is a slight discharge, I use staphisagria and adjust the food so that but little of the nitrogenous principles are taken.
I anticipate a tendency toward ulceration within the urethra, or the recurrence of a persistent discharge of purulent matter occasionally, by the use of a mild solution of sulphate of hydrastin, with a little sulphate of zinc used as an injection in warm water twice a day. This may be followed by the irrigating fluid later on.
In the treatment of this disease in females, I lay a great deal of stress upon the use of permanganate irrigating fluid, but use it much stronger and persist in its use until all the signs of local infection have disappeared.
The vagina should be dilated and the warm solution should be brought into contact with every portion of its surface.
Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.