HOSPITAL MANAGEMENT
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Abstract
It has long been recognized that the treatment of gonorrhcea is far from satisfactory, and that, notwithstanding the introduction of a large number of vaunted remedies, no man can promise a cure in any given patient. The bankrupt state of our therapeutics is especially well shown in gynrecological practice, and many men of wide experience admit that the majority of cases of chronic gonorrhceal infections in the female are practically incurable. A few years ago there was much expectation from what was termed the abortive treatment. No one places any reliance now on the prospects of a cutting short of an acute infection. The gonococcus is not difficult to kill when it can be handled; but it has an uncomfortable way of hiding within folds of mucous membrane and lacunre and other odd corners. The value of the application of efficient germicides is thus materially lessened by the fact that not all the cocci are reached during the irrigation or injection. Balsams and resins may be useful supplementations of the local application of germicides, but are too feeble in their action to be of value by themselves. The recognition of this highly unsatisfactory state of affairs, and the fact that, under certain conditions, a gonorrhceal infection ha.l' all the characters of a septieeemia, have led several investigators to seck for some means of attacking the causal organism from the blood. Vaccine treatment has, so far, not led to a satisfactory result at all events, in as far as the acute infection is doncerned. It must be remembered that gonorrhoea does not convey any appreciable protection against a subsequent attack. This probably means that the antigen, the specific proteins of the gonococcus, has but feeble powers of calling into existence specific antibodies. The serum of a person recovered from gonorrhcea has scarcely any increased bacteriolytic powers against the gonococcus, and, up to the present, no trace of an anti-endotoxic activity has been discovered in the fluids. It is claimed that the opsonic content of serum is raised by an acute attack j but there are various objections to the acceptance of this statement as evidence of increased immunity. It must be remembered that the gonococcus is an intracellular organism, and its affinity for living cells may modify the significance of its relations to phagoeytes. In these circumstances any contribution on the treatment of gonorrhcea as a blood infection should be welcomed as an advance in the right direction. Lieutenant-Colonel L. W. Harrison, having great facilities for observing the effects of treatment of venereal diseases in soldiers, has given a series of mercurial and other salts a trial, and reports favourably on the action of mercury suecinimide,' although he admits that it does not fulfil his ideal of a specific for gonorrhoea. By its use in 2,026 cases the' average time spent under treatment and observation from the day of admission to, that of discharge to full duty was 41.15 days. This represents a gain of 8.73 nays over the cases treated without mercury succinimide. The frequency of relapses was slightly lower after its use than without it. Colonel Harrison is of opinion that the intramuscular application of mercury succinimide shortens the duration of gonorrhoea, and effects a substantial reduction of the total wastage from this disease. His opinion will always command respect, and we do not doubt that many will be induced to apply this drug o~ his recommendation. He states tbat tbe best results appear to follow the injections in the early sia~es of an acute infection, and tbat an improvement may be anticipated when tbe treatment is begun as soon as the diagnosis can be made. He uses a 5% 801ution, and injects three doses of 0.05 gramme, or two of 0.075 gramme, at intervals of three days. A second course may be needed after about ten days; Ie has not obtained encouraging results from salvarsan, mercury salicylate, mercury perchloride, calomel, "enesol," "anogon," "argulan," or colloidal mercury. He records tbat he was, at the time of writing, investigating the therapeutic value of the dibromide and the benzoate of mercury. • HOSPITAL MANAGEMENT.