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LIST OF CONTRIBUTORS.

VOL. XXIV.

J. M. ANDERS, M.D., LL.D., of Philadelphia.

DR. J. CHARLES, of Grenoble, France.

E. S. GANS, M.D., of Philadelphia.

L. WEBSTER FOX, A.M., M.D., of Philadelphia.

E. B. GLEASON, M.D., of Philadelphia.

GEORGE A. HEWITT, M.D., of Philadelphia.

J. Y. HOFFMAN, M.D., of Reading, Pa.

W. C. HOLLOPETER, A.M., M.D., of Philadelphia.

EDWIN J. HOUSTON, Ph.D., of Philadelphia.

THOMAS G. MORTON, M.D., of Philadelphia.

F. SAVARY PEARCE, M.D., of Philadelphia.

ALLAN P. MACDONALD, M.D., of Danbury, Conn.

GEORGE W. PFROMM, Ph.G., M.D., of Philadelphia.

HON. W. P. POTTER.

DR. A. RAOULT, of Nancy, France.

PROFESSOR RAYMOND, of Paris, France.

WILLIAM L. RODMAN, A.M., M.D., of Philadelphia.

JOHN V. SHOEMAKER, M.D., LL.D., of Philadelphia.

F. SONTAG, M.D., of Vienna, Austria.

DR. SPECKER, of Nancy, France.

DR. F. WOHR, of Teplitz, Bohemia.

FRANK T. WOODBURY, M.D., Santa Rosa, P. I.

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GENTLEMEN: This man, 34 years of age, had impure connection three weeks ago, and one week later he began to experience burning sensations in voiding his urine. This feeling was followed by the appearance of a urethral discharge, which was not very abundant at first, but which has increased. To-day there is a copious flow of thick, yellowish pus. Five days after the beginning of the disease he became troubled by extreme irritability of the bladder. He was obliged to pass urine

every ten or fifteen minutes. The act was accompanied by much straining and a tense feeling at the meatus. He also has a feeling of weight and tenderness in the testicles. Withal, there has been, from his account, less acute pain along the urethral

tract than is usual in such cases.

From the history of the case and the nature of the discharge we can have no difficulty as regards the diagnosis. We have before us a case of acute gonorrhoea. This repulsive, painful, and contagious

dis

'Delivered in the amphitheater of the MedicoChirurgical Hospital.

No. 1.

ease is chiefly spread by sexual intercourse, and depends upon the activity of a virulent micro-organism: the gonococcus of Neisser. By proper methods of staining this organism is detected by the microscope in the pus which flows from the urinary passages. In the act of copulation this pus is brought into direct contact with mucous surfaces, and is thus transferred from one of contamination. In the case of the male to the other sex through an indefinite cycle a few drops of the infectious pus obtain the meatus and find there a receptive soil. entrance into the anterior urethra through They develop, increase, elaborate their toxins, and the result of this activity is not long delayed in manifesting itself in subjective and objective signs. In some instances this period of incubation is very short and may not exceed or, indeed, equal twenty-four hours. In other cases, again, an interval of two weeks may intervene between exposure and any sign or symptom of inflammation of the urethra. The first evidence of disease is often the occurrence of a tickling sensation at the meatus urinarius. The tickling is soon replaced by actual pain. At about the same time the orifice becomes red and puffy, a drop of thin, milk-like fluid issues from the canal, and the act of passing urine is attended by scalding pain along the urethral tract. The discharge soon assumes a distinctly purulent character. It also becomes abundant. The period during which these typical feat

in order to alleviate pain. Cubeb, belong- | nium, etc. Mixtures or emulsions of a ing to the pepper family, is better borne bismuth salt are recommended by some by the stomach, and is applicable to the writers. Naphtol and resorcin likewise acute stage. Both the powder and the have their advocates. oleoresin of cubeb are employed. The oil of sandal-wood is a valuable remedy, and may be used with benefit in the acute stage. In the period of decline copaiba and cubeb are often administered in combination.

In the increasing stage of gonorrhoea aconite is a serviceable remedy. It diminishes the turgescence of the mucous membrane. Aconite is given in 1- or 2-minim doses of the tincture every one, two, or three hours until physiological effects may be noted, when it is suspended. Belladonna is likewise of advantage at the same early period, and, as a synergist, may be combined with aconite. Belladonna is also given in the form of tincture and in doses of 2 or 3 minims. Small quantities of antimonial wine or tartar emetic are likewise of value. Another remedy which in its elimination exercises an antiseptic influence upon the urethral mucous membrane is salol, in the dose of 5 grains four times a day.

When chordee is a prominent feature a favorite prescription is a union of powdered opium and camphor, or monobromated camphor, in the form of a suppository, inserted at bed-time. Potassium bromide is also esteemed in this distressing condition. This agent may replace liquor potassæ in the emulsion of copaiba or cubeb to which I have alluded. Other drugs which have been used for the purpose of alleviating this manifestation are gelsemium and lupulin.

In the effort to counteract the effects of the gonococcus and allay urethral inflammation it has long been customary to inject astringent or antiseptic solutions into the canal. Among favorite substances which are thus employed may be named lead acetate, zinc sulphate, boric acid, corrosive sublimate, silver nitrate, and preparations of vegetable astringents, such as krameria, catechu, kino, hamamelis, gera

It is advisable to postpone the employment of injections until the activity of the acute stage has somewhat abated, as they may easily aggravate instead of mitigate the disease. When, by the use of such measures as I have pointed out, the inflammatory process has entered upon its second phase, we may begin with weak injections, which we may gradually strengthen according to the needs or indications of the case.

In the man before us we witness the first period of gonorrhoea, and we will best serve his interests by the use of means which will diminish the local inflammation and neutralize the work of the gonococci. In this instance I shall therefore prescribe:Ę Salolis, gr. v.

Tincturæ belladonnæ, mij.

M. et ft. capsul. No. j.

Sig. One such capsule to be taken four times daily.

This, together with the hygienic injunctions to which I have alluded, shall constitute the sole treatment for the present. When the discharge shall have somewhat decreased and the pain lessened he shall have as an injection:

R Zinci sulphatis, gr. iv.

Plumbi acetatis, gr. x.
Aquæ hamamelidis dest., f3ss.
Aquæ rosæ, fiiiss.-M.

Dr. E. C. Seguin.-A portrait of the late Dr. E. C. Seguin has been presented to the Academy of Medicine by Mrs. Seguin.

Dr. Rixey a Hospital Director.-Dr. P. M. Rixey, of the United States Navy, who acted as attending physician to President McKinley, has been appointed a member of the Board of Directors of the Columbia Hospital for Women in succession to Dr. Louis W. Ritchie, deceased.

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