The principles and practice of modern surgeryPark, Roswell
Science
The principles and practice of modern surgery
Park, Roswell
Surgery
With deep extension of the disease and its added symptoms of tenesmus,
pain local and referred, etc., the limit of the injection should be
extended and the entire urethra should now be treated. The bladder
being empty, the patient should make a strong effort to empty it
again at the moment when fluid is being injected into the urethra;
the compressor muscle being thus relaxed, the fluid passes into the
deep urethra. It will take a little practice to enable him to do this,
but when once learned the procedure is simple, and those who cannot
accomplish it in the standing position will succeed if they lie down
before making the attempt. In this way the entire urethra may be
traversed.
In the treatment of deep urethritis it is not necessary to change the
formulas or drugs above advised.
Under this line of treatment it may be possible to cure the majority of
cases of gonorrhea in from two to five or six weeks. This by no means
indicates that the lesion is actually cured, for trifling evidences,
such as adhesion of the lips of the meatus, with the retention of a
drop or so of mucopus, and the presence in the urine of the so-called
“clap threads,” _i. e._, threads of flocculent material that consist
of mucus and epithelial debris loaded with bacteria, will for a long
time be noted. These appearances indicate that there are still areas
along the urinary tract which are infected, and are sources of possible
danger.
The _vesiculitis_ which often follows deep urethritis, as shown by the
enlargement of the vesicles, detected by rectal examination, requires
physiological rest, hot sitz baths, hot enemas, and opiates, the latter
usually by suppository. After a short time the vesicles should be
“milked” with a finger in the rectum, gentle pressure being made toward
the prostate in the direction of their outlet. This will frequently
cause an outflow into the urethra of pus and debris and give great
relief. Should the infection persist and the above manipulation prove
insufficient, the vesicles may be opened through the rectum, washed
out, and packed with gauze.
CHRONIC GONORRHEA, OR GLEET.
Gleet is the name given to gonorrhea which persists, being only partly
influenced by treatment, and which has extended over an arbitrary
period placed usually at six weeks to two months. Strictly speaking
the term _gleet_ should be restricted to cases where there is a
mucopurulent discharge from the meatus, often complicated by formation
of strictures in the _anterior_ urethra; on the other hand, a _chronic
gonorrhea_ may for a long time persist in the _deep_ urethra and
the glands and ducts adjoining, whence will issue a discharge which
appears anteriorly, but, nevertheless, comes from the depths of the
genito-urinary tract.
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