The  use  of  astringent  injections  should  be  strictly  avoided  until
the  stage  of  decline,  for  the  reason  that,  as  stated  before,  in  the
ascending  stage  the  gonococci  are  in  the  deeper  layers  of  the  mu-
cous membrane  and  subepithelial  tissues,  and  they  cannot  be  de-
stroyed, at  this  time,  by  the  use  of  astringents,  which  also  act  as
chemical  irritants  and  interfere  with  phagocytosis.
The  improvement  in  the  symptoms  of  the  patient  is  caused  by
the  fact  that  in  the  stage  of  decline  the  gonococci  have  been  elimi-
nated from  the  deep  tissues  and  are  now  growing  on  the  free  surface
of  the  mucous  membrane  of  the  virethra,  and  the  erosions  are  being
healed  by  the  formation  of  squamous  epithelium..
These  facts  can  be  demonstrated  by  finding,  with  the  micro-
scope, colonies  of  gonococci  growing  on  desquamated  cells  of  epi-
thelium, which  are  contained  in  the  discharge.
Under  these  conditions  a  combination  of  an  astringent  and  an
antiseptic  as  an  injection  is  called  for,  in  order  to  destroy  the  gono-
cocci, heal  the  erosions,  and  contract  the  dilated  blood-vessels.
Syringes  are  of  various  shapes  and  made  of  soft  rubber,  hard
rubber,  and  glass.  An  important  point  to  observe  is  that  the  nozzle
is  not  prolonged  into  a  snout,  which  would  irritate  the  mucous  mem-
brane of  the  fossa  navicularis.  In  addition,  it  is  essential  that  the
syringe  should  hold  from  three  to  four  drachms  of  fluid,  so  that  when
the  injection  is  given  the  folds  of  the  urethra  may  be  fully  distended.
