Diseases of the urinary and male sexual organs / by William T. Belfield.
- Belfield, W. T. (William T.)
- Date:
- [1884], ©1884
Licence: Public Domain Mark
Credit: Diseases of the urinary and male sexual organs / by William T. Belfield. Source: Wellcome Collection.
326/372 (page 312)
![Treatment.—Tins must usually be both general and local ; the former is sometimes successful where local applications have failed. The exciting- cause should be in every case ascertained ; while this is usually gonorrhoea, yet thepossibihty of an additional irritation,, such as phimosis, haemorrhoids, or s1,ricture, should be remembered. The patient is, moreover, often the sub- ject of neurasthenia, induced largely by the mental depression and anxiety which usually accompany the prostatic difficulty ; hence quinine and iron, strychnine and phosphoric acid may assist materially in the treatment of chronic prostatitis, as they often do in the later stages of an obstinate gonorrhoea. Cases are recorded, indeed, in which change of climate and occupation has cured a previously intractable case. The patient is usually melancholy and despondent, especially if, as is often the case, noctui'nal pollutions are frequent; the physician should therefore, as an important preliminaiy to treatment, gain his confidence by tact and sym]5athy and by disiDelling his exaggerated fears as to the gravity of the complaint. Whenever there is a history of gonorrhcea a careful exploration of the m-ethra should be made ; since even a stricture of large calibre, not de- tected by the ordinary sounds, is sufficient to prolong and intensify, possi- bly to originate, a chronic prostatitis. The local treatment includes the avoidance of all influences which tend to maintain or aggravate prostatic congestion ; hence daily evacuation of the bowels must be secured ; the urine should be only faintly acid and not concentrated ; walking and riding, when they produce or aggravate pain in the perineum, should be avoided ; sexual excitement may be permitted only at intervals of ten days or two weeks ; the usual injunction to abstain entirely from intercoiu'se is irrational, since continence maintains a contin- ual, though perhaps slight congestion of these parts. Decided though temporary improvement is obtained by the application of flying blisters to the perineum ; for this purpose most authors recom- mend cantharides, either as plaster or collodion. To avoid the possible ir- ritating eftects upon the bladder and prostate I am in the habit of employ- ing French mustard leaves, which are permitted to remain only long enough to redden the surface distinctly. These may be applied to difter- ent parts of the perineum at intervals during several hom's in the day. Warm hip-baths should be administered once or twice a day ; and if there be constipation^ warm enemata will not only secui'e an evacuation of the rectum'but also benefit the prostate directly. Internally the bromide of potassium is a most valuable agent. During the day it can be administered only in small doses because of the drowsi- ness otherwise produced, but at night a full dose (forty to sixty grains) should be given combined with ten grains of jDotassium bitartrate (Eosen- thal). Full doses of ergot and atropia have produced excellent results in individual cases, usually vigorous subjects. The most effectual measures are those addressed directly to the pros- tate thi'ough the lu'ethra. Foremost among these is the daily use of a steel sound, which is permitted to rest in the m-ethra for five or ten min- utes unless the patient complains of pain. At first sounds of medium size. No. 8 to Xo. 10 English, should be employed ; but larger instruments should be successively introduced until the full calibre of the meatus is attained : if this be small, it should be enlarged so that a Xo. 14 or Xo. 15 can be introduced. Instead of sounds the psychrophor of Winternitz may be employed ; this is merely a closed catheter through which a con- stant cun-ent of water can be passed. The temperature should be at first ibout 60 F. and the sitting last thi'ee to five minutes ; the water may be](https://iiif.wellcomecollection.org/image/b20385420_0326.jp2/full/800%2C/0/default.jpg)
