Similarly to it is treated Acute Epididymitis (inflammation of the testicle). With the first signs of its development, all injections must stop, and the patient has to stay in bed until all acute swelling and pains are gone, which takes usually from two to three weeks. Locally, cold in the form of ice bags, or heat with the hot-water bottle, are used. They are both good, but in either case the applications have to be kept up persistently. Their selection depends upon individual preference and feeling of relief experienced by the patient. Locally, different ointments are used to reduce and soften the swelling.
Deep Gonorrhea can be cured only by deep injections, with a special instrument called instillator, of a few drops at a time of strong germicide drugs.
Extremely useful also and commonly used are irrigations with a fountain syringe of large quantities of antiseptic and soothing solutions, which fill up the bladder and effect a thorough flushing of the whole urethral canal. These irrigations are used under most variable conditions, and are often used preceding or concluding instrumental treatment. Their efficacy depends on the systematic and persistent use and a careful and exact grading of the strength of the solutions.
Granulating patches or row spots mentioned above as the source and origin of strictures can be treated only by the urethroscope described before, by localizing them and touching them up with cauterizing medicines. This treatment is supplemented by stretching with the steel sounds and irrigations. The treatment of strictures is very similar to this, and mainly consists of stretching with gradually increasing in size sounds and irrigations.
Finally, Prostatitis is treated mainly by massage of the prostrate gland, which is done by a finger inserted per rectum. This massage, made once or twice a week, is one of the most valuable parts of the treatment of chronic Gonorrhea, because in no other way can pus and gonococci be eliminated and carried out from the deep recesses of the gland as thru massage. Prostatic massage is usually followed by instillations or irrigations.
Prognosis (Probable Duration and Curability of Gonorrhea).
Treatment of all deep chronic complications of Gonorrhea takes usually from two to six months, and sometimes longer if the case is neglected. Patience and persistence in treatment is an absolutely indispensable condition for success, and patients who take treatment for a while and then drop it because, in their opinion, their case is incurable are throwing away their only chance of cure. The fact of the matter is that chronic Gonorrhea, if treated properly and patiently, can be considered a thoroughly curable disease. The incurable cases make up not more than 5–10% of the total number of cases properly treated, and these few exceptions are usually neglected old strictures, which of all Gonorrheal complications are the hardest to cure.
Gonorrhea and Marriage.
After the treatment of chronic Gonorrhea is completed; after all visible signs and symptoms have cleared up; after the patient has resumed, with the permission of his physician, his usual mode of life, a momentous question comes up before the patient—when can he marry with an absolute assurance that he will not transmit his sickness to his wife; in other words, when can it be stated that he is absolutely cured? That the answer on this question may mean happiness or misery in life for the patient is realized and recognized by all intelligent people. But it seems to be unknown and commonly overlooked that to give a positive and definite answer to this question is a matter of great responsibility and of greatest difficulty, even to the most experienced and highly-trained specialist. Only those who know how treacherous are gonococci, what ability they have to lie dormant for many months or even years in the deep recesses of the body and then on some provocation to waken up to new activity, only those know how hard it is to get the system rid of them, and how difficult it is to be sure of their complete elimination. And yet almost in all cases a physician is able to tell with reasonable certainty whether the patient is able to get married without danger of transmitting the infection, but to arrive at such a definite conclusion a physician must undertake a whole series of different examinations and special tests, as only repeated, persistent, negative tests for Gonococci can be accepted as conclusive. A man who comes to a physician and insists that the physician should render his verdict at once demands the impossible, and the hasty conclusion he will force out is not worth much.