There is no doubt that the treatment of gonorrhoea by hand injections has fallen into some disrepute of late years. Indeed, some surgeons have entirely abandoned this means of treatment. In was not, however, so much the method that was at fault as the fact that we were unable to employ any antiseptic in a strength sufficient to kill the gonococcus without also injuring the urethral mucous membrane. Most of the injections in common use were merely astringents, and, as such, are still very effectual in subduing the catarrh remaining after the complete removal of the gonococcus.

The introduction of the silver albuminoids, by far the most effectual of which is argyrol, has, however, given us a weapon with which we can fight the gonococcus without injury to the urethra. Argyrol is a compound of silver and vitellin, a proteid extract from wheat. This salt, which contains 30 per cent of silver, was first used in ophthalmic practice. It is quite bland when applied to the conjunctiva in a strength even of 25 per cent. That it will kill the gonococcus is shown by its effect in gonorrhoeal conjunctivitis. In a case of double purulent gonorrhoeal conjunctivitis recently admitted to the London Lock Hospital the eyes were mopped out every four hours with a 50-per-cent solution of argyrol. The eyes were also bathed every half-hour during the day with a saturated solution of boric acid. By the third day the pus, inflammation, and catarrh had quite disappeared. The patient stated that he did not feel any pain from the application of argyrol.

In spite of the fact that Pedersen, Swinburne, and Chetwood, of New York, Christian and Kevin, of Philadelphia, together with the others of the modern school of American uro-genitary surgeons, have all recorded long series of excellent results of treatment of gonorrhoea by this salt, it is only recently that any attention has been given it in Great Britain.

At the London Lock Hospital, where there is unlimited material for observing the effects and contrasting the results of different methods of treatment. I have the opportunity of investigating the treatment with argyrol. In eight cases of acute anterior gonorrhoeal urethritis, in which treatment was commenced within fifteen days of the appearance of the discharge, six days of the appearance of the discharge, six days’ treatment was sufficient to insure the disappearance of all obvious discharge, and within a fortnight all flocculi had disappeared from the urine.

In addition to a series of twenty-four cases published in the Lancet of the 19th December, 1903, the following are some in which the treatment had given excellent results. Although in the first cases treated a solution of 5-per-cent argyrol was used, it will be seen that almost as good an effect was obtained with a 2.5-per-cent solution. In some cases the argyrol was only used once in the evening after the discharge had ceased, together with injections of sulphate of zinc (1- 8 gr. to 1 oz) three times daily, Thus, as is the case also in those treated by irrigations, it is found, after the gonococci have been killed, advisable in most cases to complete the cure by using astringents. As in my first series of cases, the best results were obtained with in patients, although no special diet was given, and the men were not confined to bed during the day.

W.F., twenty-six years of age, journalist, admitted 2nd February, 1904, with anterior gonorrhoeal urethritis of fifteen days’ duration, not previously treated.

Patient was put on a mixture of resin of copaiba and injection argyrol 5 per cent. After washing out the urethra by syringing with a saturated warm boric lotion, two drachms of the argyrol solution was injected, and held in the urethra for 5 minutes. On the 6th February the discharge had ceased. Flocculi were, however, present in the urine. On the 7th February a 2.5-per-cent solution of argyrol was used only at night one hour before retiring, whilst zinc-sulphate (1-8 gr. to 1 oz.) was used thrice during the day. The latter injection was held in the urethra for two minutes. February 11: No “floaters.” Urine quite clear. The copaiba and all injections were stopped, the patient simply continued treatment with a mixture containing salol 10 gr. and acid soda phosphatis 20 gr. thrice daily. There having been no reappearance the least suggestive of shreds or flakes after repeated urinations into series of glasses, the patient was discharged on the 14th February.

R. P., aged twenty-two years, pipe fitter, admitted from on the metropolitan unions. History of gonorrhoea for three weeks’ duration. Profuse discharge of gonorrhoeal pus, pain on urination, and chordee. February 23: Received first night 1 oz mistura alba. On the 24th one injection of argyrol 2.5 per cent. This was continued thrice daily until the 1st of March, on which day he received only one injection. On the evening of the 25th February, after four injections, there was no discharge, although two white cotton-like threads were seen in the first urine-glass. On the first three days of March repeated examinations of the urine failed to give any indication of flocculi. He was discharged on the 4th March.

C.M., aged twenty-two years, valet: Gonorrhoea seven weeks, not previously treated owing to phimosis. On the 22nd February, four days after circumcision, he was put on an injection of argyrol, 2.5 per cent, every three hours. No injection was used after the fourth day, since when there has been no discharge up to the present date, 24th March. This patient, being at the same time under treatment for syphilis, has also been under daily observation.

A. R., aged fifty-three years, asylum attendant, acute anterior gonorrhoeal urethritis, three weeks. First attack. Chordee with ardor urinae. On the 27th February patient was put on pulv cubaebae 2 dr. thrice daily, and injection of argyrol, 2.5 per cent., only once a day one hour before retiring. On the 4th March he received three injections of sulphate of zinc during the day. On the 7th March “floaters” were still present. On the 10th the urine was quite clear.

Among cases recently treated in the out-patient department are the following:-

No. 1253. Shop-assistant, age twenty-two, gonorrhoea three weeks. 16th January, mistura copaiba resin and injection argyrol 2.5 per cent thrice daily. 30th January, discharge ceased. Injection zinci sulphatis during the day, argyrol in evening. 8th February no “floaters” urine clear and sparkling.

No. 1089. Blacksmith, age thirty-one. 16th February. Gonorrhoea one month. Resin of copaiba with injection argyrol 2.5 per cent. On the 1st March no discharge, no “floaters”, urine clear.

No. 1466. Labourer, age twenty-five. Gonorrhoea one week. 19th February, sandalwood-oil and injection argyrol 2.5 per cent. 24th January, patient reported that the discharge ceased on the 21st after four injections. Examination of urine showed “floaters,” smallest possible size, uncoloured. Put on injection zinci’s sulphatis. 8th February, no return of discharge, “floaters,” still present. Put on argyrol again. Patient has not returned. As discharge had been absent ten days when last seen, it is probable that there has been no relapse.

No. 1246 Warehouseman, aged eighteen. Gonorrhoea three weeks and a half. 16th January, put on copaiba resin and injection argyrol 2.5 per cent. On the 30th January no discharge. On the 6th February “floaters” still present. Put on injection zinci sulphatis twice daily, argyrol once in the evening. On the 13th February patient reported “no discharge”. A few “floaters” were still seen. On the 20th February the urine was quite clear.

No. 3058. Dustman, age twenty-three. Gonorrhoea three days. 28th February, pulvis cubeae and injection argyrol 5 per cent thrice daily. On the 11th January patient reported that discharge had ceased on the 3rd January. He was then put on injection zinci sulphatis (1-8 gr. to 1 ox.). On the 18th January there have had been no return. Examination of three urine glasses were negative.

After an extensive trial of this salt in sixty-four cases, in which an accurate record has been kept, in addition to others at present under treatment, I have no hesitation in saying that so far I have seen no treatment for acute anterior gonorrhoeal urethritis which is so satisfactory, both to the patient and the surgeon, as that above described.

In argyrol we have salt which is certainly a bactericide, and which kills the gonococcus without injuring the mucous membrane. Whilst the treatment with argyrol is as effective as the method of irrigation, I consider it is more serviceable as entailing the loss of less time in its application both from the point of view of the surgeon and the patient. The chief point in its favour, next to its efficacy, is that patients never complain of any pain after using it, as is the case when other silver salts are used in strengths much less than those used in the treatment of gonorrhoea by argyrol.