The injections.

Each one was

of the urethral or surrounding structures followed. were repeated a number of times during ten days. followed by a temporary subsidence of the discharge, which promptly recurred. At first the injections were repeated daily, then at longer intervals. After ten days they were stopped and ordinary treatment instituted, under which he slowly recovered, the entire time being about five weeks.

CASE III.-The first injection in this patient, who was a young man with a pale-face but in good health, and suffering from true. gonorrhoea, caused the penis to swell along its entire length, increas ed the pain and (after twenty-four hours) the discharge to such an extent that he refused further trial of the method and went on with an aggravated gonorrhoeal attack lasting about three months, and more or less complicated by mild gonorrhoeal cystitis.

CASE IV-Was a fresh case of true gonorrhoea in a mulatto. But little swelling followed the irrigations. The discharge was temporarily arrested by each injection, and then went on as before. After three weeks the method was given up, and a slow cure effected by ordinary means.

CASE V. was a counterpart of Case II.

In these five cases the utmost care was used in making the injections, which were done without any violence, a very small rubber soft catheter being used and a fountain syringe.

My experience comprises two other cases treated primarily by other physicians.

CASE I.-During the summer of 1883 I was called in consultation by a gentleman having charge of a case which had been under the care of still another medical man. I was informed that the patient had been submitted to the deep urethral hot-water irrigation method for the cure of a gonorrhoea.

When I saw the patient he was confined to his room in bed with a high fever and great perineal pain. His discharge was better than it had been, but his prostate by the rectal touch was found to be very seriously congested, hot, tense, throbbing, and all the indications pointed toward probable prostatic abscess.

By methodical treatment he slowly improved, there was no abscess, the urethral discharge came back-as is its wont-when the prostatic swelling subsided. When I last heard from his physician, recovery was assured. I cannot state the exact number of weeks during which this patient's discharge lasted.

CASE II. This case is the most brilliant of all. The patient is

now on his back in bed at the end of the eighth week with a free urethral discharge.

The history is as follows: In July, 1883, one year ago, this patient came to me with his first attack of gonorrhoea.

I knew that the family was (urethrally speaking) an inflammable one. The patient had only three brothers. One had twice been under my care with bad attacks of gonorrhoeal rheumatism. The second, with a prolonged gonorrhoea of many months' duration, treated in the country, had had an inflamed inguinal gland which required many months for its dissipation without suppuration. The third had a sharp urethral discharge which lasted him the better part of a year.

With such knowledge I treated the patient most carefully, avoiding injections. He recovered in about two months, with no complication greater than a little urgency upon urinating toward the close of his treatment.

Eight weeks ago, while sitting in Delmonico's, he became conscious of a slight urethral discharge. He confided the fact to a friend sitting beside him; and his horror of the disease which had been two months in getting well a year before. The friend said to him that there was no need of being so long as that getting well of gonorrhoea, that he would take him to a doctor who would "fix him in a week." True prophet, alas! for in a week the patient certainly was "fixed"-upon his bed, where he has remained ever since. The doctor, be it understood, was a thoroughly competent practitioner.

The method was as follows: Every hour while awake during the day the patient was told to inject his urethra-with an ordinary syringe-with water as hot as the urethra could tolerate, and three times a day he was to take a full hot bath, and while in the bath to inject his urethra under water with the hot water of the bath as many times as possible. This he faithfully did for a week. On the fourth day he began to feel pain on urination deep in the perineum. His calls to urinate became frequent and urgent. The doctor said that this was not important, and ordered him over and above the hot water to use an astringent injection. This the patient did, and, his sufferings steadily aggravating, he sent for me on the eighth day. He said that the treatment had certainly been effective in stopping the discharge, but he had the piles frightfully, and the doctor had given him an ointment to apply outside. He was, however, growing suspicious of the treatment, so he sent word to the doctor that he was well and would call upon him shortly,

and then hurried a messenger to me. Possibly he may yet come to be recorded by his physician as a cure of gonorrhoea by hot water injections in a week.

I found the temperature 104°, intense perineal pain and urgency of urination, no pus flowing from the urethra, but plenty of it in the urine-in short, the case was one of gonorrhoeal cystitis and prostatitis of a high grade, induced by the peculiar treatment I have detailed above.

The cystitis to-day-seven weeks later-is well, the prostatitis nearly so. There has been no abscess, but the patient has had active epididymitis, which has relapsed three times, the patient being all the while kept flat upon his back in bed. A new wave of inflammation, without known cause, would seem to pass over his prostatic sinus and vesical neck, and shortly there would be a relapse of the inflammation in the testicle. Now the testicle is reasonably quiet, and the urethral discharge has, naturally, returned in creamy abundance. Dr. Samuel Alexander two days ago found an abundance of gonococci in the urethral pus.

As for other methods of aborting gonorrhoea. I have not tried eucalyptol, but I have experimented with iodoform suppositories, and with frequent injections of weak corrosive sublimate solutions.

The iodoform bougies have failed me totally, but have done no harm. I have used those of Kelly and Durkee, two grains, coumarin one-twentieth grain each.

With corrosive sublimate injections I commenced with one-quarter grain to the ounce of water, but found it too strong for frequent use in a virgin case. Some old stagers liked it and confessed moderately good results as having followed its use in their cases of spurious gonorrhoea. I then reduced to one sixth grain in the ounce, but was totally disappointed in its use. With such a solution injected three or four times a day, I did not succeed in aborting a single case of gonorrhoea out of several in which it was tried.

On one occasion, after a plastic operation upon a healthy urethra to close a fistula in the scrotal portion, I attempted to irrigate the urethra by a small rubber catheter passed beyond the point of the former fistula with a one-in-two-thousand (one-quarter grain to the ounce) solution of corrosive sublimate, a solution with which I had washed the wound thoroughly and with which surgeons freely irrigate ordinary wounds without causing irritation.

The soft-rubber catheter could only be passed once beyond the scrotal point where the fistula had been. The urethra swelled so

much that it became temporarily occluded at that point, and after two days an abundant creamy suppuration occurred under a continuance of the injections which persisted for a number of days after the injections had been suspended.

My conclusions, therefore, are-my temporary conclusions, I should say, for they are based on too imperfect data to allow accurate generalization—

1st. A mild bichloride of mercury solution irritates the mucous membrane of the urethra more than it seems to irritate an open wound.

* 2d. It appears that an abortive treatment of true gonorrhoea is yet to be discovered.

3d. The hot-water treatment of gonorrhea is unreliable.

THE RELATIVE MERITS OF ETHER AND CHLOROFORM AS ANESTHETICS.*

BY J. W. PARKINSON, M. D.

[Pacific Medical and Surgical Journal.]

Having assumed, and perhaps proved, that an apparatus is essential for the comfortable and steady administration of ether, while chloroform can be given without any special contrivance, the possession of such apparatus gives to neither anesthetic superiority in point of time. Excluding the quantity of the drug required to produce the effect, anesthesia by ether can be induced with some practice and attention to detail in an average time of two minutes; whilst as far as my personal experience goes the range is from 40 seconds to 10 minutes. This result is barely equaled by chloroform, for whilst the average time is about the same, the range is limited in one direction and extended in the other.

Few will be prepared to deny that the induction of anesthesia with chloroform in less time than one and a half or two minutes would be attended with greatly increased risk to the subject; whilst the period of ten minutes is not infrequently exceeded in fruitless efforts to produce insensibility.

The preliminary stage of excitement, which is more marked in

* Conclusions of a paper read before the Sacramento Society for Medical Improvement,

ether than chloroform administration, can usually be considerably shortened by concentration of the vapor.

When the use of ether became tolerably general, and before efficient inhalers had been constructed, the persistence of this stage, which often became alarmingly violent, led to the erroneous supposition that for operations requiring absolute muscular relaxation, as reduction of dislocations, fractures, etc., ether was inadmissible. Practical experience and improved surgical appliances have fully disproved this, and there is no stage of anesthesia which cannot now be as readily reached and maintained by this agent as by chloroform.

RELATIVE SAFETY AND DANGER-In estimating the safety of an anesthetic, we may first assume its general applicability, and that no special contra-indications exist. Granting that ether and chloroform are equally admissible in any case, to determine their relative safety it will be necessary for a moment to consider their physiological action.

Both drugs, if we accept the theory, produce the anesthetic state by causing "a decrease and cessation of that molecular motion," on which we agree all organic processes depend. As the phenomena of active life depend primarily on the healthy functional activity of the two great centers, circulatory and respiratory, so it follows that any reagent which causes paralysis of one, and in a much greater degree of both, must be used with extreme caution. Both chloroform and ether, as a rule, lower the vascular tension and decrease the cardiac impulse. This holds good in the majority of cases after the patient has passed the preliminary stage of excitement. While universally true in the case of chloroform, there are many exceptions to it where ether is the agent employed.

In numbers of instances carefully observed, and in experiments on animals, it has been proved beyond question that the vascular tension and cardiac impulse continue unchanged throughout the period of insensibility, and in some instances are positively increased.

Briefly, the ultimate effect of these agents, if pushed to toxic extremes, is in the case of ether to produce arrest primarily of the respiratory and next of the circulatory center; in that of chloroform, first of the circulatory and next of the respiratory center, but very frequently of both simultaneously.

Ether acts partly by paralyzing the pulmonary circulation, and