GONORRHCEA. 89 



After encountering the stone and fairly grasping it, an operation 

 which requires tact in manipulation, the stone is crushed by slowly 

 and gradually turning the screw. Then the instrument should be 

 withdrawn, and when the irritation has subsided, subsequently in- 

 troduced, to crush the fragments. Thus many operations may be 

 required to reduce the stone into fragments sufficiently small to pass 

 the urethra. 



It is not to be expected that fragments will escape at the first 

 urination : the after treatment should consist of diluent drinks, and 

 bland injections to accelerate their passage ; and it may be that the 

 hip-bath, anodyne enemata, and leeches, will be required. The 

 sources of danger are the irritability of the bladder, and urethra ; 

 inflammation often resulting from the irregularity of the fragments, 

 and too frequent introduction of the instrument. Sometimes frag- 

 ments are arrested in their passage through the urethra : a bougie 

 or catheter should be introduced, of large size, and the fragment 

 pushed back into the bladder : should it become impacted, it may 

 require a special instrument for its extraction, or an incision in the 

 perineum. 



Jacohsonh instrument is used by many. Its extremities are con- 

 nected by a link : thus a loop is formed to grasp the stone when 

 the blades are separated in the bladder. By the operation of the 

 screw, the female blade is pulled upon the male; whereas in Heurte- 

 loup's the male is pushed upon the female, — thus there is less danger 

 of fine fragments or sand being caught between the blades of the 

 latter, which would impede the movement. 



VENEREAL DISEASE. 



The history of this disease is involved in some obscurity, although 

 it is generally believed to have existed from the earliest ages. It 

 consists of GonorrhcBa and Syphilis^ which are usually considered 

 as distinct diseases, although there are high authorities to the con- 

 trary. 



GONORRHffiA. 



Gonorrhoea is an acute inflammation of the lining membrane of 

 the urethra, commencing in its anterior portion. It is caused by 

 matter from another, during sexual intercourse. In about five days 

 a discharge appears, although it may occur in a few hours, or not 

 until ten days after coition. 



Symptoms. — Heat, itching, redness of the glans, and swelling of 

 the orifice of the urethra ; the stream of urine is small and at- 

 tended with burning and smarting ; the dwelling, redness, and pain 

 increase ; the discharge is no longer limpid, but turbid, puriform, 

 and profuse, sometimes being mixed with blood ; the thighs, loins, 

 testicles, and groins sympathize in a dull pain, and there may be fever. 



9 



