The principles and practice of modern surgeryPark, Roswell
Science
The principles and practice of modern surgery
Park, Roswell
Surgery
No routine in the treatment of gleet will give satisfactory results
beyond this fact, that patients should be instructed to regulate their
lives by absolute rules as regards indulgence of every description,
and avoidance of intestinal inactivity and constipation. The urine
will be found concentrated and irritating in many of these cases, and
this should be overcome by the free use of water and diluent drinks.
Hyperacidity should be corrected by suitable alkaline medication,
and remedies administered, already mentioned, which are supposed
to medicate the urine. Capsules may be procured containing salol,
oleoresin of cubebs, balsam of copaiba, and pepsin, and except in cases
where there is already great irritation of the urinary tract, these
serve their purpose admirably.
When the anterior urethra alone seems to be involved, one of the
milder injections already mentioned in describing the treatment of
acute cases may be employed. When the deep urethra appears to be the
site of continued irritation, it should then be treated extensively
with deep irrigations and injections of suitable medicaments. The deep
irrigations can be practised with or without the use of a catheter.
The deep urethra may be flushed through a smaller catheter than the
urethra will comfortably take, allowing the fluid to return through the
urethral channel outside of the catheter itself. When this practice
is adopted, hot water which has been made antiseptic should be used,
preferably with one of the silver salts. The nitrate may be used in
proportion of 1 to 500, and the citrate or lactate in strength of 1 to
300 or 1 to 400. Protargol is effective in 1 per cent. solution, or
argyrol in 1 to 3 per cent. strength.
In the employment of irrigation in these cases a shield should be
used, by which the end of the penis may be covered and all danger of
spattering avoided. The simplest expedient for this purpose is one-half
of an old atomizer bulb, which may be punctured and slipped over the
catheter or irrigator tube.
Apart from mere irrigation it is well to deposit within the depths of
the urethra, in the membranous portion, by means of a deep urethral
syringe, a drop or two of a fresh solution of silver nitrate in
distilled water, in strength of ¹⁄₂ to 1 per cent. This should be
deposited behind the “cut-off” muscle, where it will cause a burning
sensation for a short time. The strength of the solution is to be
regulated by this complaint, as no benefit is derived from using it too
strong.
Of all the medication that has been suggested, nothing gives better
results for this purpose than this silver nitrate.
For ordinary urethral injections, besides those already mentioned,
formalin may be used, but in weak solution (1 to 2000, or stronger if
the patient can tolerate it); while picric acid has been recommended by
Belfield and others in strength of 1 to 1000 or 1 to 2000.
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