ON HUTCHINSON’S TREATMENT OF 
GONORRHOEA—A SATISFACTORY 
PLAN OF DEALING WITH THIS 
DISEASE IN THE MALE. 
By W. P. ARNOLD, M. D., 
Passed Assistant Surgeon United States Navy. 
Ike Georgia Journal of Medicine and Surgery. 
-EDITED BY- 
St. J. B. Graham, M D., J. 6. Van Marter, Jr., M. D., 
W. E. Fitch, M. D„ 
SAVANNAH, GA, TH EC 
GEORGIA JOURNAL 
OR 
MEDICINE AND SURGERY, 
ISSUED MONTHLY. 
VOL, 1. 
SAVANNAH, GA, AUGUST 15th, 1897 
No. 2. 
On Hutchinson’s Treatment of Gonorrhoea—A Satisfactory Plan of Dealing 
with this Disease in the Male. 
[By W. F. Arnold, M. D., Passed Assistant Surgeon U. S. Navy.] 
“My treatment of gonorrhoea in all 
stages has for long been very monotonous. 
Almost without regard to stage or degree 
of severity, I prescribe the same reme- 
dies. I have long ago laid aside the tra- 
ditions of my student days, which taught 
that salines only should be used in the 
acute stages, and that abortive plans were 
dangerous. I always use abortive meas- 
ures, and mostly, I believe, succeed. At 
any rate, I never encounter ill-consequen- 
ces, and complications are rare. My pre- 
scription is a partnership of three differ- 
ent remedies, and it is, I believe, impor- 
tant that they should all be used. First, 
an injection of solution of chloride of zinc, 
two grains to the ounce; next, sandalwood 
oil capsules, and, lastly, a purgative 
night-dose, with bromide of potassium. 
The injection is used three or four times 
a day; the capsules (10 or 20 minims) 
taken three times a day. The ingredients 
of the night-dose are three drachms of 
Epsom salts, and half a drachm of brom- 
ide of potassium. It is, I believe, the 
action of the last named in preventing 
congestion of the parts which makes the 
abortive measures safe. Moderate pur- 
gation and entire abstinence from stimu- 
lants are essential. If the case is very 
acute and attended by swelling of the cor- 
pus spongiosum, I sometimes prescribe 
tartar emetic or tincture of aconite, but it 
is very seldom indeed that these are neces- 
sary. If the patient be well purged, there 
is no risk whatever in an abortive treat- 
ment from the day that he comes under 
treatment. The risk of orchitis, pros- 
tatitis, cystitis, etc., comes in cases which 
have been allowed to develop rather than 
in those treated abortively. I should as 
soon think of delaying to use local meas- 
ures in gonorrhoea as I shouhl in purulent 
oph th aim ia. ”-Jona than Hut chin son’s Archives 
of Surgery, vol. 1.11, page 236. 
Some time ago I published* the results 
of my experience with Jonathan Hutchin- 
son’s method of treating gonorrhoea in 
men; and, in my dissertation thereupon, 
I claimed that reasonably satisfactory 
progress to complete recovery and a prac- 
tical immunity from complications and 
from the usual sequelae, were attainable 
by adherence to it. My enthusiasm at 
that time afforded me much patroniza- 
tion upon which I exercised my patience. 
I recall now the advice to wait until 1 
should have treated gonorrhoea acquired 
from Chinese women in China and gon- 
orrhoea in the tropics before commending 
so highly any plan of treating it. 
It is the object of the present note to 
emphasize everything contained in the 
paper referred to in commendation of 
this plan of treatment, and to set forth, 
as the basis of my statements, the results 
of my observations of gonorrhoea in the 
male subsequent to the date of that pa- 
per—April 15th, 1894. 
The present account will deal with 50 
cases; 36 were met with on cruising men- 
of-war, 8 were presented by civilians, and 
6 have been observed to ray satisfaction 
aboard my present ship. 
*Some Observations on Gonorrhoea in the Male.—“ The 
Southern Practitioner,” Nashville, Tennessee, June, 
1894. Reprint. GEORGIA JOURNAL OF MEDICINE AND SURGERY. 
From April 15th, 1894, to the first of 
the following August, I treated quite sat- 
isfactorily to myself and to my patients 
7 cases on board a man-of-war, that 1 shall 
designate A; from and including August, 
1894, until late in October, 1894,1 treated 
12 cases aboard another man-of-war, call- 
ed, for present purposes, B. The cases 
that the crew of B acquired were derived 
in great part more or less directly from 
the motley throng that the Mid-Winter 
Fair had attracted to San Francisco; and 
the men of this ship’s company may be 
fairly presumed to have lost by enforced 
continence much of the immunity to this 
disorder and of the (at present unnamed) 
influences that modify its severity, which 
repeated attacks at short intervals un- 
doubtedly confer, (I am not unaware that 
the latest views of Bumm—in Veit’s 
“Handbuch der Gynaekologie,” 1897 
admit only immunity for the particu- 
lar attack and for the given, spe- 
cial stock of the organism by means 
of, possibly, functional changes in the 
protoplasm of the regenerated epithelial 
cells. But, being willing to trust some- 
thing to the statements of experimenters 
perhaps as indefatigable as that author, 
and certainly no whit less practical in 
their methods of acquiring knowledge, I 
am content to await with all confidence 
the formal announcement of the reversal 
of this decision.) The cases that they pre- 
sented were treated under circumstances 
that cannot be called favorable to the 
treatment by any stretch of construction, 
as the ship was either on blue water or in 
a port within the tropic - throughout their 
entire course. Nevertheless, only one pa- 
tient, a fireman, was excused from duty; 
he was allowed a respite for 4 days after 
I had reduced a rather severe paraphimo- 
sis. A patient that was incompletely 
treated by the Junior medical officer of 
the ship—without the injection, as nearly 
as I remember—developed orchitis and 
peritonitis and narrowly escaped death; 
and a month later another member of this 
crew, who had treated himself for several 
weeks before Hutchinson’s treatment was 
applied was admitted to the sick list 5 
days after this treatment had been adopt- 
ed, and a fortnight after I had been trans- 
ferred to another ship. The entire sum 
of disabilities aboard the ship B from gon- 
orrhoea that was acquired in the quarter 
of this year from July to October, are rep- 
resented by these 3 cases, which gave 44 
sick days. I claim exemption from all but 
four (4) days of this disability for patients 
treated according to Mr. Hutchinson’s 
plan. 
Aboard 0, as I shall designate the last 
cruising vessel on which I served, a 
crew of less than 150 men and officers 
somewhat inured to service in Oriental 
countries afforded 17 cases of gonorrhoea 
in nine months’ sojourn in China and two 
months’ in Japan. In the preceding year 
there had been about 30 cases aboard this 
ship. I take this from an unofficial record 
of the venereal cases that were met with 
throughout the entire cruise of the vessel 
that I found on board without an owner; 
the number of complications, etc., that 
they yielded are shown in the accompany- 
ing table. 
Not one of the cases that I treated 
aboard C afforded either complication or 
sequel. Two men were excused from 
duty—one for two (2) and the other for 
six (6) days—in order to permit them to 
care for themselves, as there was not, at 
that time, an attendant of the slightest 
special training in the medical depart- 
ment of that ship. A landsman that was 
transferred to her from the flagship de- 
veloped orchitis the same week in which 
he came aboard; but he confessed to hav- 
ing treated himself for three weeks prior 
to his transfer to my ship. I bore a case 
of upffil thetw- 
ords of this vessel for a month; the pa- 
tient had been left by one of our men-of- 
war in a civil hospital in a port in which 
my ship spent some time alone. Hence 
only eight (8) days’ loss of service in a 
year may be properly charged against ury 
17 gonorrhoea patients, and this small 
matter is a solecism in my practice. 
CASES 
SHIP 
B 
SHIP 
C 
1893 
1891 
1895 
1st 
6 M 
1891 
1895 
1896 
1st 
6 M 
Orchitis and Epididymitis... 
6 
16 
8 
4 
1 
Abscess and Adenitis 
2 
4 
6 
1 
1 
2 
12 
5 
2 
Gonorrhoeal Rheumatism... 
1 
4 
1 
Total sick days 
125 
221 
251 
103 
8 
37 
This table shows the complications 
and sequelce that resulted upon other 
approved plans of treatment on board 
the vessels designated B and C. Un- 
fortunately I am not able to give the 
number of cases of gonorrhoea that pre- 
sented on board these ships for the pe* 
riod covered by the table. I have avoided 
giving any clues as to the real names of 
the vessels to which I refer, as far as I 
could do this and use the material which 
they have afforded me. I wish to claim ORIGINAL COMMUNICATIONS. 
nothing over their medical officers, who 
are of the very best that our Naval Ser- 
vice can furnish. Whatever credit may 
accrue hence is clearly Mr. Jonathan 
Hutchinson’s. 
tions, I found a case of urethritis—it is 
not, of course, embraced in the foregoing 
account—that presented no gonococci. In- 
stead, the pus from the urethra showed 
numerous bacilli; and a guinea-pig that 
had received a drop or two of it intraven- 
ously died on the third day in collapse, 
after severe diarrhoea. For that reason, 
I suspected infection with Bacillus coli 
communis, although I had not the op- 
portunity to prove it by examining the 
blood and organs of the guinea-pig. I ex- 
amined some pus that was derived from 
a woman’s urethra for Dr. S. M, Mouser 
in San Francisco in 1894, and I found, in 
company with numerous cocci that were 
assumed to be the common pyogenic 
forms, the same bacillus, to all morpholog- 
ical appearances, that my sailorman had 
presented. No gonococci were found in 
this case either. It is possible that either 
one or both of these cases were 
of a piece with the two cases 
reported by Josipovice, in “Centralb. 
Krankheit/- der Harn und Sexual- 
organen.” Band Heft 10, p. 663, as 
having been caused by the colon bacillus. 
I am most sorry to have been unable to 
follow up more fully the two cases that I 
have mentioned; and I regret likewise my 
inability to obtain a specimen of the ure- 
thral discharge from a gentleman in 
Northern China, who claimed such dis- 
charge was due to the fact that his penis 
had suffered frost-bite in the winter of 
1894-95. 
It is not without interest to observe 
that the disability ascribable to this dm 
■ease for the year 1895 for the entire Na- 
val Service of the United States, appears 
to have been about 14,000 sick days. It 
stands fifth in importance, the list of 
diseases causing loss of service in 
the year 1895, malarial affections, 
preceding it in the order given. There 
were more admission from wounds, 
sprains and contusions in the class of in- 
juries than from this disease, whose ad- 
missions are given as 330, 57 cases of the 
number having been treated in the various 
naval hospitals. The complications and 
sequels of the cases of gonorrhoea are not 
returned so as to afford an idea of the 
proportion which they bore to the number 
of cases of the disease. These figures re- 
late to an average strength of force of 
13,191 men and officers, which afforded/ 
158,495 sick days 
These considerations indicate to me 
that something more is necessary besides 
contagious-disease acts to increase the 
efficiency of the English-speaking military 
services. This is too large a question to 
be interjected here; although I must say, 
before I leave the subject, that I do not 
expect the improTement to come through 
the efforts of the White Cross League, of 
which the Archbishop of Canterbury is 
the President. (See 11 The Lancet,'1'1 1897, 
1., p. 1633.) 
No culture-tests were made in any of 
the cases dealt with in this article. 
The average duration of the treatment 
in 43 of these cases was 23.1 days; in the 
remaining seven cases, it could not be as- 
certained for various reasons. Restric- 
tions to the limit of the ship for about a 
week longer than this period was ordi- 
narily insisted upon with the idea of pro- 
tecting in a slight degree the companions 
(all too frequently the best ones, as bad 
as they are) of Jack’s hours of liberty on 
shore. 
I may say that I have found the routine 
character of this treatment of the great- 
est usefulness in my experience, which 
embraces more than a hundred cases. The 
only addition that I have presumed to 
make has been the early and constant use 
of the suspensory bandage. I have never 
interfered with my patients’ diet beyond 
stopping their beer. 
I have not found the oil of sandalwood 
to disagree seriously with any of my pa- 
tients further than to offend the senses of 
some fastidious Lotharios; but an intelli- 
gen pharmacist in Shanghai told me that 
he had seen a person or two that 
could not use it on account of the 
severe griping pains in the bowels 
that it invariably and immediately 
caused them. It is not an easy matter 
to get a pure article of this expensive 
stuff in this country; nevertheless our 
pharmacopoeia! tests are easily applied 
The popularity of the Santal Midy cap- 
sules is proof positive of the value of the 
article in the treatment of gonorrhoea. 
While this preparation seems usually of 
One week’s cessation of notable dis- 
charge from the urethra has served me 
constantly as my warrant for discontin- 
uing all treatment except the injection; 
this I like to have continued for two 
weeks after all of the usual symptoms of 
gonorrhoea have subsided. This expla- 
nation must be considered in connection 
with the average length of the treatment. 
For the sake of completeness in my 
records, I made (or procured) confirma- 
tion of the diagnosis with the microscope 
in 82 per cent, of these cases. In the 
course of these microscopical examina- GEORGIA JOURNAL OF MEDICINE AND SURGERY. 
reasonable purity, it is most needlessly 
expensive and quite shamelessly adver- 
tised in the press and on dead-walls. 
ate. I reason that it is necessarily a dis- 
pensary treatment, and that it is doubtful 
whether the value of a return-irrigation 
(or an auto-irrigation) of an infected ure- 
thra with a solution of potassium per- 
manganate that could not, before any re- 
duction of its strength had resulted, have 
exerted a sensible action as a disinfect- 
ant, is superior to the same action by the 
patient’s urine impregnated with oil of 
sandalwood or with products derived 
from it. Janet’s adherents claim cures 
in ten days in all temperate patients; the 
proprietors of the Santal Midy capsules 
advertise publicly that their preparation 
will cure in just one-half of that time. I 
think that the decision of the merits of 
these contentions may safely be left to 
the future. Meantime, I commend the 
above plan of treating opprobrious clap to 
the much-insulted, “under-educated,” gen- 
eral practitioner; to the military medical 
man both afield and afloat, and to such 
others as do not yet feel it their duty to 
administer manually all of the treatment 
to this “highest grade of parasitic adapta- 
tion to man.”* 
U. S. Receiving Ship “Richmond,” Nacy 
Yard, League Island, Philadelphia, Pa., 
June 24, 1897. 
I have not found the injection to cause 
either pain at the time of using it or irri- 
tation subsequently, provided the urethra 
be not occluded by dressings, in spite of 
its unusual strength. In fact, I think 
that its strength is its chief recommenda- 
tion; for I am convinced that the tena- 
cious prejudices against all injections, at 
least in the early stages of the disease, 
owe their origin to superadded infections 
that were seen to have been caused by 
them. And small wonder, when they were 
so weak, to suit the irritated urethra, that 
they could hardly fail to carry infection 
along with them. As a rule, infection 
with the gonococcus alone does not give 
the worst cases of urethritis. I do not 
accredit the chloride of zinc with such 
specific germicidal powers over the gone- 
coccus as I think must be yielded to sil- 
ver nitrate in solutions of fair strength- 
say, from 1-100 upward. I should use 
(and sometimes I have used) the latter to 
extinguish at once a localized, accessible 
gonorrhoea, just as it is used to cure gon- 
orrhoeal ophthalmia, and to prevent the 
establishment of ophthalmia neonato- 
rum. Still, I think that I know that zinc 
chloride will, in conjunction with the 
other agents named above, confine gon- 
orrhoea in the male urethra to its ante- 
rior portion, and that it will cure it there 
in a reasonable time with positive cer- 
tainty. 
* While the foregoing was in the printer’s hands, the 
first case of epididymitis occurred that I have known 
to follow the treatment commended above when ap- 
plied in its entirety. I know now that its subject drank 
much raw spirit in the course of the treatment, which 
was begun on the fourth day after exposure and con- 
tinued for two weeks. There are reasons for thinking 
that neither he nor my subordinate were as assiduous 
as thev might have been in applying the treatment 
from which the suspensory bandage was omitted alto- 
gether, although the man was doing heavy work all of 
the time. 
Holding this view, I give small heed to 
the numerous dispensary doctors’ present 
laudations of Professor Jules Janet’s 
method of vesical irrigations with very 
dilute solutions of potassium permangan- 
To offset this misadventure, a brother medical officer, 
wno was doing my work during a temporary absence 
of mine, released one of my cases from restriction to 
the ship after only 10 days of treatment for a severe case 
of gonorrhoea upon the strength of mistaken reprosen- 
tations. Although this man h«d a frightful debauch 
on shore from which he returned almost poisoned with 
bad liquor, be had no gonorrhoea.