The writer has seen cases of postgonorrheal toxemia of extremely chronic and even fatal type, where the joints were conspicuously involved and where they did not constitute the most serious features of the disease. These cases proved most intractable to treatment and illustrate the possible complications of gonorrhea.
In addition to the joints various bursæ and tendon sheaths may suffer in the same way as do the joint membranes. Such lesions are seen about the hands and feet, especially about the tendo Achillis, and are also seen in the muscles of the neck and of the orbit.
The treatment of these gonorrheal complications should be effected largely by improving elimination and getting rid of the general toxemia; thus hot-air baths, diuretics, and cathartics are advisable. These eliminants, with free massage, are useful in dislodging the toxic products.
Treatment.
—The treatment of gonorrhea is directed not alone toward the mere alleviation of symptoms, but to the destruction of the invading germs. The patient should abstain from much exercise, and in cases of severity should be kept in bed, avoid alcohol and tobacco, and eat sparingly of meats and of richly seasoned foods. He should wear a “gonorrhea bag,” or large condom, and there should be no obstruction to the outflow of pus. His hands should be washed immediately after contact with the parts involved, and all dressings and linen which may have been contaminated should be promptly burned.
The actual treatment of gonorrhea should be both internal and local. Internal treatment should consist (1) of the administration of laxatives; (2) of such amount of alkali as may be necessary to overcome hyperacidity of the urine and mitigate the distress caused during its passage; (3) of remedies which, being eliminated by the kidneys, serve to medicate the urine and give it the effect of a retrojection; (4) of such anodynes and sedatives as may be necessary to give comfort, allay distress, and produce sleep or relieve and prevent chordee.
Of the drugs which are supposed to be eliminated by the kidneys, the balsams have sustained a high reputation. Among these is cubebs, of which 2 or 3 Gm. may be taken every two or three hours, as this remedy favorably influences the amount of discharge, though sometimes disturbing the stomach. Of the oleoresin of copaiba a ¹⁄₂ Gm. capsule, taken several times a day, is more pleasantly borne by the stomach, and with nearly as good effect as cubebs. Copaiba is known to produce a vivid scarlatiniform rash. The oil of sandal-wood, or santal oil, is the most efficient of these remedies, and may be given in the same dose as copaiba. That these drugs are eliminated by the kidneys is shown by the odor which they impart to the urine. It must be said, however, that these remedies are of but trifling benefit until the bladder is involved; when this occurs, they may prove of great value.
The urine should be diluted that it may be less irritating, and also to overcome its acidity. Fluids should be administered in profusion and alkaline diuretics in considerable doses. Hyperacidity is readily controlled by the administration of liquor potassæ, or the common sodium bicarbonate.
Sedatives may be necessary even from the first. The stronger anodynes are rarely needed during the first day or two, but by the end of the first week vesical tenesmus and chordee may be so marked that remedies such as cannabis indica, lactucarium, chloral, and the bromides may prove insufficient, and an opiate should then be administered. When required, morphine or heroine subcutaneously and in doses sufficient to promptly bring about the effect desired are preferable.
The local treatment of urethritis is directed to the alleviation of discomfort and distress and the cure of the local disease. Much has been said about abortive treatment. There is no such thing as aborting the disease. Much may, however, be done in the way of mitigating and shortening its course, and mild cases, especially of the non-specific form, may be considerably relieved within a few days.