B Zinci sulph.;

Ext. belladonna, ãã 0·60 = grs. x;
Glycerine, 60.00 = zij;

Aqua, 200.00 = 3 vjss.

M. S. For injection.

Recently Dr. Bryant has proposed the irrigation of the urethral canal with a solution of corrosive sublimate, 1 to 40,000 parts of water. More than three years ago I endeavored to cure a number of cases of gonorrhoea by allowing various solutions to flow into the urethra from a fountainsyringe through a catheter, but I found the method troublesome, without deriving an equal amount of benefit from it.

In protracted cases in which the deeper parts of the urethra are involved, and the acute inflammatory symptoms have entirely subsided, I cause deep urethral injections to be made with a long-nozzle syringe, or use Mitchell's medicated bougies. The latter, however, are not always tolerated, for they act as foreign bodies, and the pain they occasion does not subside till the melted ingredients of which they are composed have been ejected. In these cases I have very often succeeded in effecting a cure by making applications of a two-per-cent solution of nitrate of silver through an endoscopic tube with a fine brush. Having first ascertained the exact location of the affected part by means of conical probes, the tube is inserted, pushed in so far that its internal end touches the diseased part, and then the solution is applied.]

The use of cool sitz-baths is of material service when combined with the local treatment. In some cases it is useful to combine the local with the internal treatment by means of the ethereal-balsamic remedies, especially in those cases in which the local measures already recommended have been faithfully tried without accomplishing any good results, particularly if no contraindications, such as digestive disturbances, are present. Lastly, attention should be paid to the possible presence of hæmorrhoids, hyperæmia of the rectum, irritation of this organ by ascaridis, anæmia, scrofula, etc. These require appropriate treatment before a successful result can be attained in obstinate cases of chronic gonorrhoea.

The Indirect or Internal Treatment of Gonorrhoea of the Male Urethra.

The indirect or internal treatment consists in the employment of certain remedies, which when introduced into the system are in greater part excreted by the kidneys, then pass with the urine through the urinary apparatus, and exercise in this manner a curative effect upon the diseased mucous membrane. This also explains the reason why these remedies are only effective in gonorrhoea of the male and female urethra, and not in gonorrhoea of the vagina and uterine canal, and have little or no curative properties in gonorrhoea of the eyes and rectum. These remedies may be introduced into the system either through the digestive or the respiratory organs— possibly also by a prolonged application upon the integument. Among these are the following remedies: Copaiba, balsam of Peru and Tolu, turpentine, cubebs, ol. santal. flava, the socalled wood-oil, or gurgon balsam, and, lastly, certain preparations of matico.

Up to the present time balsam of copaiba has remained the favorite remedy. Its unpleasant taste, however, is a great hindrance to its administration, and many ways have been devised of disguising it. The best is by inclosing it in gelatine capsules; each capsule usually contains from six to seven drops of copaiba (capsules de Mothes et de Raquin). Others give balsam of copaiba in aromatic tincture, or in the form of pills (copaihine Mège of the French). If it is desired to administer it in its purity, it should be ordered to be taken three or four times daily, fifteen to twenty drops each time, on a lump of sugar, or in some liquor prepared as follows:

Ę Tinct. aromat. acid., 5·00 [iv];

Balsam copaiba, 20:00 [3 ss., Div].

M. S. Fifteen to twenty drops to be taken four times daily.

For the purpose of administering it in pills, it is best combined with magnesia. Thus we order:

B Bals. copaiba, 10:00 [ 3 ij, Dijl;

Mag. ust. q. s. ut form. pil. pond., 0·30 [grs. v].
S. Six to eight pills to be taken four times daily.

Or, the balsam of copaiba, made in pills and wrapped in wax, as in the following formula:

Cera albæ, 5.00 [iv];

Adde: Bals. copaiba, 10:00 [ viij];

Pulv. magnes. q. s. ut ft. massa pilul. forment pilul.

pond., 0·30 [grs. v], consp. pulv. eodem.

S. Eight pills to be taken three times daily.

[The following are excellent formulæ for administering copaiba in emulsions or pills. These combinations are better tolerated and less objectionable on account of their disagreeable taste, and very efficacious:

Mix the copaiba and the liquor potassa and the ext. of liquorice and spirits of nitre first separately, and then add the other ingredients. (Bumstead.)

S. A tablespoonful after each meal.

B Copaibæ, 60·00 = 3 ij;

Bismuth subnitratis, ãã 60·00 = 3 ij.

M. To be divided in pills of 0.3 grs. v each, and coated with sugar.

In this prescription the cubebs serves as a stomachic; the alkali and the bismuth are also good anti-dyspeptic remedies.]

Balsam of Tolu is met with in commerce as an inspissated, resinous substance, which, before using, must be dissolved in spirits of wine. It has no unpleasant taste, but as a remedy is inferior to the other resinoids used in the cure of this disease.

The black Peruvian balsam is administered in the same manner, and in similar doses, but is seldom used, on account of possessing little medicinal virtue.

The therapeutic properties of oil of turpentine are almost as great as those of balsam of copaiba, but this oil is even more unpleasant than any of the remedies already spoken of.

It is best administered in pill form, generally combined with an astringent or iron:

B Zinci sulphas puri;

Terebinth. laricis, aa 1 00 [grs. xvj];

Pulv. rad. ratanhiæ q. s.

M. Ut ft. pil. No. 30, consp. pulv. cinnamomi.
S. One pill three times daily.

R Ferri sulph., 5.00 [iv];

Terebinth. laricis, 2:00 [grs. xxxj];

Pulv. lycopod. q. s. u. f. pil. pond., 0.20 [grs. iij], consp. pulv. cinnamomi.

S. Five pills to be taken three or four times a day.

Cubebs, piper caudatum, may be administered either in powder or pill form; for the latter, the ethereal extract or freshly powdered berry is well adapted. The following formulæ may be used:

B Pulv. piper cubebiæ recent., 20:00 [3 ss., Div];

Sacchar. lactis, 5·00 [iv].

M. S. Divide in doses equale No. 12. To be put in capsules, and taken in forty-eight hours.

B Pulv. piper cubebiæ recent., 20.00 [3 ss., Div];

Ext. juniper;

Syr. simplex, ãã, 50.00 [3jss., Div].

M. S. To be taken in twenty-four hours.

If a cure is to be achieved by means of cubebs, the patient will have to take from 13.00 to 15.00 grammes [ 3 iijss. to 3 iv] of the remedy in twenty-four hours.

Grimault, of Paris, has introduced the use of the so-called matico capsules. They contain an ethereal oil, prepared from the leaves of the drug matico, piper angustifolium or elongatum, extract of cubebs, and balsam of copaiba. We never succeeded in effecting a cure by the administration of maticooil alone, but we did with matico capsules. The latter are preferable to the copaiba capsules, in so far as they are better tolerated, owing probably to the oil of matico, which seems to act as a stomachic. Of these matico capsules, from nine to fifteen should be taken daily. The so-called "injection végétal," made of matico, and known under that name in commerce, contains ethereal oil of matico and sulphate of copper.

Now, experience has shown that many persons suffer from vomiting and diarrhoea as the result of the internal administration of the antiblennorrhoea-balsamic remedies, and in others a prolonged use of these remedies will occasion chronic gastric and intestinal catarrh. But the injurious effects produced upon the digestive organs are not the only evils occasioned by them. In some patients they also give rise to a peculiar eruption of the skin. Attended by gastric and febrile disturbances, groups of pale, wheal-like eruptions develop about the wrists, hipjoints, and especially on the face. They resemble nettle-rash very closely, and, like the latter, cause severe burning and itching, especially when the patients get warm in bed. This affection of the skin is called urticaria balsamica, and, owing to its resemblance to roseola syphilitica, was until quite recently regarded by some physicians-Cazenave, for instance-as proof that gonorrhoea was the initial disease of syphilis. That this assertion is incorrect is proved by the fact that the eruption disappears as soon as the use of the remedy is discontinued.

It is also asserted that the ethereal-balsamic remedies exercise an injurious effect upon the kidneys, in consequence of which Bright's disease is said to result. Now, if to the urine of a person who several hours previously had taken cubebs, copaiba, or turpentine-oil, some strong mineral acid is added, an opalescent, gelatinous sediment is precipitated which might be readily mistaken for coagulated albumen, but it is distinguished from the latter by the fact that it again becomes soluble on boiling, or on the addition of alcohol, carbonate of potash, or ammonia. The researches of Berzelius and Johnson have shown that the constituent elements of the balsamic remedies are an ethereal oil and a resinous acid. The experiments of Drs. Weikart and H. Zeissl have proved that the precipitate above alluded to is not due to the ethereal oil. Consequently, we can explain its production by the following theory: The resinous acids are the vehicles containing the curative principles; in the intestines or blood they combine with the potash or the soda and form a soluble resinous soap in the excreted urine-a resinoid potash or soda. If to such urine a stronger acid than the resinous acid is added, for instance, nitric acid, the resinous acid that is insoluble in water is precipitated as a whitish sedi