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DRUGS IN COMMON USE IN UROLOGY.

THE urinary system lends itself to medication, fordrugs are secreted by the kidneys to a greater extentthan by other organs, and drugs so excreted, or injecteddirectly into the urinary passages, come into close andsometimes prolonged contact with the organs whichform the system. In the lungs and the skin there isrelatively little excretion of drugs and the area overwhich it occurs is large. The intestine tends toabsorb drugs which we would like to act locally,and it is difficult to ensure that the required actiontakes place at the right spot.A paperl by Dr. Hugh H. Young, of Baltimore, on

the Value of Drugs in Urology, reminds us that thelarge class of urologists in America deals with a broaderfield than the much smaller number of British genito-urinary surgeons or of physicians who specialise indiseases of the kidney. But as we recently noted, theSection of Urology of the Royal Society of Medicineis enlarging this session the scope of its view. Dr.Young discusses the value of drugs used in his ownpractice and tabulates the frequency with which theyare used by other leading urologists. An account ofthe drugs described is of interest generally and alsoas showing the practice in America.

Urinary Disinfectant8 Given by the llouth...Hea’ecmMte.—Emphasis is laid on the necessity of the

patient taking little fluid, so as to concentrate the drug,and on keeping the urine acid ; if the urine is not acidthen the active agent, formaldehyde, is not liberated. Thetotal dose for the day is 60 to 90 gr. and 5 or 10 gr. of acidsodium phosphate may be taken every four hours betweenthe doses of hexamine.Oleum santali is perhaps the best of the volatile oil anti-

septics and is still popular in acute gonorrhoea.Chlor-mercury fluorescein, a compound from which phenol

sulphonephthalein is eliminated in the urine, has been givenby the mouth, and acriflavine and proflavine have beeninjected intravenously in rabbits, and both have producedantiseptic urine without injury to the animal.

Local Antiseptics in Urology.Important factors in these are : the amount of

albuminous precipitate formed, the diminution of theactivity and the loss of penetrating power due to thisprecipitate, and the strength of the drug which canbe used without irritation. The older the infectionthe more deeply will the infecting organisms havepenetrated to the surrounding tissue. Of late therehas been a great advance in our knowledge of the localtreatment of chronic infections of renal pelvis,bladder, prostate, vesicles, and urethra.

Silver salts.-c,il ver nitrate is probably the most importantantiseptic and caustic in chronic inflammations and ulcera-tions. The organic preparations, argyrol, collargol, andprotargol are colloidal suspensions and are less irritant andonly slightly astringent, but they penetrate little and haveno strong germicidal power,

-Potassium permanganate has a transient action and usedin strengths of 1/2000 to 1/10.000 is not effectively germicidal ;it acts owing to the nascent oxygen produced by its contactwith protein material.

Various dyes have been used with some success,exercising a powerful and often strongly selectiveeffect on bacteria.

Acriflavine and Proflav-9,ne.--Of these the former is moresuccessful. It can be injected to the tract up to 1/1000 orcan be used for irrigation to 1/5000. It does not coagulatealbumin and its germicidal power is not diminished in thepresence of serum, a fact which distinguishes it from otherdisinfectants. Its action depends on some unknown factorsand a long exposure to its action gives the best results.Under favourable conditions it is the most successful drugin the treatment of gonorrhoea. Its lack of staining qualitymakes it especially useful.

Britliant-;-recn is also used in gonorrhoea.-Itc-rcitrochroki2e is a compound of fluorescein and mercury

designed to have both the penetrative power of the dye andthe germicidal activity of the mercury. It does not coagulatealbumin, but its activity is somewhat reduced in the presenceof serum. It is comparatively non-irritating and is borneby the urinary tract up to 1 per cent., at which strength it

1 Journal American Medical Association, 1921, xxvii., 1327.

will sterilise a foul, badly infected bladder remarkably. Itsintense deep-red staining power is a great objection. Dr.Young thinks other drugs of this class will be brought outshortly.

Potassaztnt nzercur-ic iodide does not precipitate albuminit is irritating if used in strong solution, but for irrigationpurposes in very weak solution it is more germicidal than ispotassium permanganate.Soap.-The effectiveness of soap in venereal prophylaxis

has long been known, and it has recently been shown thatsodium oleate, especially if combined with a little boric acidwhen albuminous matter is present, is quite an activegermicide for the gonococcus, killing it in 20 minutes at adilution of 1/3000. Very weak solutions are effective inincreasing considerably the germicidal power of other drugsagainst the gonococcus. It is tolerated by the urinarymucosa in the strength of 1 in 200.

Antisyphilitic Drugs.The advantage of the combination of arsenic and

mercury is insisted on. Great reliance has still to beplaced in mercury and potassium iodide.

Mercury.-For intramuscular work mercurial oil andcalomel are said to be far inferior, as regards absorption, tothe salicylate which has largely replaced them. For nuickaction the cyanide given intravenously is to be preferred.lnunctions are still popular.Arsenic.-A simple method of giving this drug is to inject

neo-salvarsan (neo-arsphenamin) intravenously, making thesolution by placing 2 c.cm. of sterile distilled water in thecapsule itself and then withdrawing the solution from thisinto an ordinary hypodermic syringe. Possibly salvarsan(arsphenamin) is more positive in its results.

Sedatives and Anti-spasmod’ics,Morphine and codeine relieve ureteral and vesical

colic through action on the pain centres, but have adirect contracting and tonic effect on the ureter andbladder ; another component of opium, papaverin,has a relaxing and anti-spasmodic effect on smoothmuscle, and attempts have been made to aid thepassage of calculi by injection through a ureteralcatheter. Omnopon contains a large amount of

papaverin and is given internally for colicky pains ofall sorts.

Benzyl-benzoale is given in doses of 2-4 c.cm. of 20 per cent.alcoho1ic solution for subacute renal and vesical pains.Hyoscyamus has a greater anti-spasmodic action than

belladonna. A mixture containing potassium citrate andtincture of hyoscyamus is of unquestioned value.

Local anastheties.-Cocaine is not much used owing tothe severe intoxication it sometimes causes. N ot’ocaine(procaine) is only one-tenth as toxic as cocaine. It is used inthe strength of 2-4 per cent. for examinations of the bladderand urethra or 1/400 for infiltration in operations. Benzylalcohol is only 1/40 as toxic as cocaine and is used as localanaesthetic and for infiltration. In 2 per cent. strengthit is distinctly antiseptic. A solution of 10 per cent. inolive oil may be injected through the drainage-tube inperineal prostatectomy into the depths of the wound andin this way the gauze packs may be painlessly removed.

Diuretics.Water given in large quantities by mouth (10-12

quarts daily) is the simplest and best diuretic ; it maybe supplemented by saline solution injected under thebreasts or given per rectum.

Caffeine is most efficient, in cardiac dropsy, stimulatingthe heart and relaxing the vessels by direct action.

T3teobrorrtine and Sodiurrz salicylate has a similar action, buthas less effect on the central nervous system and is a betterdiuretic.

Saliiie d’H<)’e<!C9.&mdash;Potassium acetate can be used innephritis as it increases the solids in urine without irritatingthe kidneys ; potassium citrate, being less readily absorbedis less diuretic and more purgative : magnesium sulphate,though largely purgative. is also a valuable diuretic from thesmall amount absorbed and should be the purgative chosenin cases of ursemia.

CHADWICK PUBLIC LECTURE.-The next lecturewill be given in February in London, on the Plague Questionin Europe, by Prof. Van Loghem, 1T.D., of the KoloniaalInstitut at The Hague.OVERSEAS MEDICAL OFFICERS’ DINNER.-The

fourth annual dinner will be held at the Exchange Hotel,Liverpool, on Thursday, Feb. 9th, at 7.30 P.D2. Tickets,price 16s., may be obtained from the Hon. Sec., Dr. G. F. R.Smith, 19, Queen’s Drive, Mossley Hill, Liverpool.