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MEDICAL RECORD. 725 GONORRHEAL INFLAMMATION'.' By HERBERT J. HOPKINS, M.D., C.M.E.-E., PITTSBURG. Gonorrhcea proper, online viagra prices as treated by the mass of physi- cians to-day, does not redound much to their credit. In the greatness of our desire to benefit online viagra prices the patient the mistake is often made of tiying to do online viagra prices more than is at present possible. In this paper gonorrheal con- junctivitis is first discussed in order to show the limi- tations of treatment, it being of course understood that gonorrhceal inflammation, whether of the urethra, va- gina, or conjunctiva, is essentially the same disease, running the same course in about the same time and reacting in the same manner to like reagents. Gonorrhceal conjunctivitis is the most intractable and destructive disease to which the eye is subject, and for this reason, as well as for its great frequencv, it has received minute attention, and this in a locality open to free inspection and where errors in treatment are quickly followed by most disastrous consequences conditions which naturally insure the highest pos- sible perfection in its treatment. It is caused by the deposition upon the conjunctival membrane, in what- ever way, of gonorrhceal discharge, and is of course itself communicable, e.g., the discharge from one eye being capable of setting up the same disease in the other; or of causing a specific urethritis. It runs a definite self-limited course lasting from four to six weeks, and it is impossible when it is fully developed to cut it short, though its severity can be mitigated and its phenomena controlled to such an ex- tent as to preserve the affected tissue intact. If treat- ment be resorted to, however, immediately after expo- sure, the infecting virus can be readily destroyed and the disease prevented. This is best accomplished by nitrate of silver in a solution of from five to ten grains to one ounce of water applied freely to the part affected. It is open to the female viagra discount objection of causing considerable burning pain and any excess should be neutralized by a weak solution of sodium chloride. Gonorrhceal conjunctivitis begins like, and in its earliest stages is almost indistinguishable in appear- ance from, simple acute conjunctivitis, but it soon as- sumes its own characteristic features. During the initial stage, lasting about a week, be- fore the discharge has changed to the thick creamy character of the second stage, reliance is placed upon frequent cleansing with online viagra prices weak non-irritating solutions, e.g., of boracic acid alone or combined with perchlo- female viagra discount ride of mercury, 1 to 10,000, or with peroxide of hydro- gen. It is well, too, to begin the use of iced cloths (pieces of lint two inches square changed every two minutes from a block of ice to the lids) even in this early stage, and when once begun they are to be con- tinuously employed night and day, female viagra discount a duty which taxes the energy of two nurses. In selected cases, leeches applied to the temple or to the side of the nose online viagra prices are also of great benefit. It is not till the second stage, that of free discharge, is estab- lished that the stronger female viagra discount applications, e.g., of nitrate of silver, are allowable, nor are they then if online viagra prices there be much hard, brawny swelling. It cannot be too clearly understood, from its bear- ing upon the urethral inflammation, that the disease is a self-limited one, the duration of which we cannot shorten, though it can readily be prolonged. The proper treatment is essentially a cleansing, sedative one during the acute stages: Astringent solutions, female viagra discount e.g., of tannin, zinc, alum, etc., are not of noticeable benefit before the final stage, at online viagra prices which time they are invaluable, restoring the relaxed and thickened mem- brane to its normal condition. 1 Read before the Austin Flint Medical Club, April 14. 1S96. Though it is not directly involved in the inflamma- tory process the greatest danger in this disease is through the cornea, and its condition is a vital index by which to gauge the measure of our success. Its nutri- tive supply being interfered with by the inflammation of the surrounding tissues, its substance yields readily to the corrosive action of the discharges, the first evi- dence of trouble noticed being usually at the sclero- corneal female viagra discount junction in the form of a faint nebulous zone of infiltration, which speedily breaks down, forming a trench whose depth and length rapidly increase till female viagra discount perforation occurs, and even the whole cornea becomes detached and drops off. This female viagra discount ulcerative process may begin very early in the disease or not till near the end. As special measures to save the vitality of the cornea, hot fomentations are sometimes indicated in- stead of the iced cloths, and even scarification of the conjunctiva to deplete the strangulated tissues. In children the well-known tendency of inflamma- tion of mucous membranes to expand itself chiefly in. the direction of cell proliferation and consequent free discharge is exemplified in this instance. In early life gonorrhceal conjunctivitis (ophthalmia neonato- rum) is characterized by the very abundant creamy- discharge and but comparatively little of the brawny swelling so noticeable in the adult, and as a conse- quence stronger and more frequent applications of nitrate of silver are female viagra discount recommended; but iced cloths to reduce swelling are not so urgently indicated. It is important to note, from its bearing upon simi- lar cases of urethritis, that under the classical term gonorrhceal conjunctivitis are grouped the simple pur- ulent cases arising from infection from healthy ab- cesses, leucorrhceal discharges, and various chemical irritants in which the gonococcus has no part. These are comparatively mild in character, of shorter dura- tion, and yield readily to antiseptics.