On the pathology and treatment of gonorrhoea and spermatorrhoea / by J.L. Milton.

  • Milton, J. L. (John Laws), 1820-1898.
Date:
1887
Catalogue details

Licence: Public Domain Mark

Credit: On the pathology and treatment of gonorrhoea and spermatorrhoea / by J.L. Milton. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    ally met with in spermatorrhoea, which will really yield to treatment, and there are very few that will not. Patients usually labor under the impres- sion that in treating stricture it is absolutely necessary to distend it stead- ily, progressively, and it may be forcibly. This is a mistake, and especi- ally in regard to traumatic and retractile stricture. At no time does any such amount of excessive force as may give pain prove serviceable; in the two latter forms it is the very reverse. Of course a patient who has just made some progress, say got up from number four to number eight, is exceedingly mortified at finding that he must go back all at once, not to four, but to three or even two; but this must count for nothing against the certainty of aggravating mischief by attempting dilatation when the canal will not bear it. At such times what is wanted is, not the largest- sized bougie that can be got through the constriction, but a size that will pass into the bladder without setting up irritation. Traumatic stricture is occasionally met with as an accompaniment of spermatorrhoea; it is a very distressing complication, and one which sometimes long defies the most sedulous care, the pain and irritation behind the seat of injury being often but little influenced by art. In a case in my practice, where a blunt instrument entered the urethra from the perineum, the patient continued for years after to suffer most severely from the symptoms I have just men- tioned. They seemed to be quite unaffected by treatment. Connection, he said, always aggravated them. Stricture, when there has been an an- tecedent neglected gonorrhoea, may also prove extremely obstinate. Twice I have seen enlargement of the veru montanum spring up dur- ing treatment, and to such an extent as to impede the passing of an in- strument, however small, the stream in both cases remaining, according to the patient's account, as large as ever; in both these cases I felt rather doubtful as to whether the repeated use of. the nitrate might not have contributed to the disposition, though it seemed so difficult to reconcile this possibility with the fact that scores of patients, who had been cauter- ized quite as extensively, had never had anything of the kind. At least four times I have noticed what certainly seemed to me the form of strict- ure at the neck of the bladder so well described' by Guthrie, and have found it very troublesome in every instance, requiring a most persever- ing use of gentle dilatation. In the absence of a more suitable place I may add here that forced dilatation of the rectum, commended to M. Trousseau as a remedy for spermatorrhoea by M. Adolphe Kichard, has been employed by Dr. Bar- tholow with excellent results. 8. Irritable state of Foresl'in.—Whenever there is an accumulation of sebaceous matter under the prepuce, it should be got rid of as quickly as possible Avith soap and water, aided by the subsequent use of an astring-