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even for years, before it subsides. This form is found in persons of gouty constitution, or who suffer with irritation of the bladder or kidneys.

Another termination of gonorrhoea is termed gleet, by which is meant the persistence, often in spite of various treatment, of a scanty, thin, pale white discharge from the urethra. Sometimes the quantity is sufficient to afford a drop whenever the urethra is pressed, at others a drop of matter is obtained only in the morning, on rising from bed. Lastly, there may be only a little continual moisture, with a drop of pus now and then. The sensations felt by the patient at this stage of his disease rarely exceed a little occasional itching and smarting. These obstinate discharges, though unimportant in many cases, as they often continue through life without producing any inconvenience, should always be cured, as at any time they may cause irritation of the genital organs, and rekindle violent urethritis, or inflammation of the prostate or neck of the bladder. A little obstinate discharge is often the outward sign of the formation of an organic stricture, which, growing slowly and imperceptibly, will eventually cause much trouble. There is another danger, too: the state of the patient's mind induces him to constantly examine his genital organs; he grows morbidly anxious about himself, becoming not unfrequently hypochondriacal and unable to pursue his occupation in life, or enjoy society; he is rendered miserable by the dread of various evils, real and imaginary; and in this condition he becomes desperate, and a willing victim of quacks and charlatans.

In gleet the mucous membrane is usually pale and moist, and thickened over a small part of the urethra, where the inflammation has not ceased. The parts which recover their healthy tone least readily after gonorrhoea are the fossa navicularis near the external orifice, and

the bulbous and membranous parts. If the gleet comes from the fossa navicularis, there is often a little tenderness en pressing the urethra about an inch below the meatus, and a little pus oozes from the opening. If the discharge comes from the bulb, there may be a little tenderness if the urethra be pinched behind the scrotum, but usually not even this remains. A very characteristic sign of the condition of the deeper part of the urethra often escapes obser vation, namely, the appearance of little threads of clotted discharge in the urine. These clots are formed in the deeper parts of the urethra in the intervals of micturition, and should be looked for in the urine passed on rising in the morning, when a long interval has elapsed after making water. Besides the foregoing conditions, a small wart, an alter, or an enlarged follicle in the floor of the canal is sometimes the cause of the discharge and point of tenderness. Relaxation of the prostate, when its ducts continue to secrete a small quantity of muco-pus, will often keep up a constant this discharge. Lastly, a debilitated condition of the system, such as scrofula, in which all mucous surfaces are prone to secrete pas, may be the real cause of the discharge from the urethra, without any special local lesion to account for it.

In such various ways the natural course of the disease is interfered with and hampered, so that mismanagement, as much as the peculiar character of the disease, produces the frequent relapses and obstinate continuance of the disclage did so constantly characterise the course of

"ky took—Gonorrhea may be most readily confounded wita a arctricis set up by non-contagious irritation. But in this all indammation begins immediately after the guplication of the irritant. In gonorrhoea the symptoms av excelfy delgred till four or five days have elapsed after Pe apare intercourse. The course is usually more severe

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in gonorrhoea than in non-specific inflammation. distinctions serve as a general rule, but often fail to render the diagnosis certain, for purulent inflammation of nonspecific origin is occasionally as violent as any gonorrhoea, and as difficult to quell. The only occasion where an absolute diagnosis is required, occurs when question of unchastity is raised in connection with the origin of the discharge, and in these cases the surgeon will, of course, give a decided opinion only on the clearest evidence.

Another affection which is not unfrequently mistaken for gonorrhoea is urethral chancre. This form of chancre is, if not close to the meatus, most frequently an indurated one; it is usually situated at, or just within the meatus, very rarely more than a third of an inch away from that point, hence it can be easily felt as a tender spot becoming hard: I have felt it an inch and a quarter below the meatus, but this is exceptional. The amount of the discharge is very slight, the symptoms of irritation such as erections, pain in the body of the penis, and prolonged smarting after making water are absent, and enlargement of the inguinal glands with other signs of syphilis show themselves.

Balanitis may be mistaken for gonorrhoea, especially for that form in which the glans penis is inflamed as well as the urethra; but in balanitis, when uncombined with gonorrhoea, there is no discharge from the urethra. Micturition is painless if the foreskin be drawn back so that the urine does not trickle over the inflamed part. The readiness with which the inflammation is reduced by cleanliness, is also a very distinctive character of balanitis.

Syphilis. Constitutional syphilis has been in very rare and exceptional cases known to succeed discharge without induration. This apparent anomaly is caused by both affections having been contracted at the same time, for we know persons can suffer from the two diseases at once, and

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de narous renince via svilen and infamed by gono—and his bel for the absorption of syphilitic

Sing this swan slik is no ecnnection

TIADA A prales Exchange from the urethra

my design les réin the prostate, or near the neck of the Maller nominating with the urethra. Amazon de patent s kostry vill grid mistaking this for Fama ni ile is made to pass water into two vessels Ties Tiled list vill generally be mixed with pus. I games de lust portions of time are clear, because Demo he ani s visted away by what runs first.

Il Pryces sånne in most instances, if ordinary Ta saim ni me ther arme disease is present; marlees bstances of indl result are recorded, if to the ramies bad or server be siled. Likewise Buth has been mused by extensive infammation of the Liters hadde, or prosunt, vil formation of abscess and Kar siman. I kelly men the first clap is ordiarly de mox sere, but not always so. Immediate appearance of the gymptoms birstes a short duration, if über wadders are equal in weakly scrofulous persons gurerries lasts longer, and more frequently degenerates into a gleet than in others. When an opinion is expressed so de Dimate bonsegnence of the infammation, it must de dere in mind also, that stiture is a not infrequent rosad of generrbes, and that de Esease often lingers an indediuite sure in the form of gleet.

TREATMENT OF URETHRITIS.

Bordes trezonet, or the treatment employed to cut Dert de dæuse during the incubating period before acute information begins-While the symptoms are confined so a litle nekling at the meatus, and the discharge is a de viscid dull glueing the Ers of the meatus

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together, the gonorrhoea may be stopped by the application of a powerful caustic injection, or by administering, at short intervals, large doses of the gonorrhoeal specifics, cubebs and copaiba. For injection, a solution of nitrate of silver containing 15-20 grains to the ounce of distilled water should be employed. Half a drachm of the solution should be injected once, twice, or thrice in twenty-four hours, according to the violence of the effect produced: very often one injection is sufficient, and more are needless or hurtful. Besides nitrate of silver, various other powerful irritants are used, among them the acid nitrate of mercury dissolved in water, which I have seen cause a contraction of the meatus without cutting short the gonorrhoea. Chloroform has been injected by Venot of Bordeaux. Liquor potassæ, and other caustics, have also been tried with success about equal to the nitrate of silver. The reaction after these injections is usually violent; there is much swelling, and the pain in the penis, perinæum, and groins is severe; micturition is terribly painful for the first two or three times after the injection. Thin bloody or serous discharge oozes plentifully from the urethra, bringing with it curdy shreds of inspissated mucus. Actual bleeding of the urethra sometimes happens, but is of no moment. The discharge subsides in forty-eight hours, and, if the treatment is successful, it is easily wholly cured in a few days by ordinary means. The constitutional disturbance is often violent, shivers and headache with fever are not infrequent; to remedy these, the patient should keep. his room, wrap the penis in cloths wet with ice-cold water, drink plentifully of warm bland fluid, and if shivers come on cover himself with hot blankets. These precautions usually suffice to allay the constitutional disturbance, and the local inconvenience passes away also in a short time. But this happy result is often not attained. This failure may be because injection

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