In gonorrhcea of women, urethral gonorrhcea proper, urethritis virn lenta gonorrhcea, the mucous membrane is at first reddened; then the woman feels an itching, which soon becomes a prickling, burning pain, which is accompanied by frequent micturition and dysuria. A few (3 to 4) days later there appears a serous, sticky, albumen-like secretion, which in 6 to 8 days becomes purulent and greenish, in 20 days begins to de crease, and may have entirely disappeared in 30 to 40 days. (Boys de Loury.) Blood may be mixed with the secretion, hrematuria and vesical catarrh may occur; but from the shortness of the female urethra, and the absence of the associated organs wliich are so prone to give trouble in the male, the symptoms are not usually violent. There is often seen around the meatus a number of vividly red projecting points, which are the in fected and swollen orifices of the glands of the part. (Strenbel.) This, Scanzoni asserts, is a true folliculitis of the inner surface of the upper parts of the nymphm. Occasionally theso itifl Lined glands cause small abscesses, the affection spreads to the rest of the vulva, an abundant pur ulent and foul-smelling secretion appears, and finally the entire vulva is infected. With this there usually occur dysuria and strangury, the spas tic contraction of the sphincter vesicie causing the patient much trouble. The pain caused by urination leads the patient to retain her water as long as possible, and besides this, the urine flowing over the inflamed parts around the external urethral orifice causes violent itching and burning, often leading the patient to rub and scratch the affected parts violently. But rarely do abscesses of the vesico-vaginal septum occur. (See Cory's case.) Lewin has found that many women having urethritis and ulcera tion of the urethra suffer from an exudative erythema from reflex vaso motor stimulus.
If the process becomes chronic, the secretion decreases in amount, the redness diminishes, and the color of the parts becomes a livid blue. The entire canal is hard and infiltrated, though it is not painful. A sort of hypertrophia urethrae may gradually appear, the parts around the urethra, especially the anterior vaginal wall, being involved. Loosening of the mucous membrane leads to varicosities in it, and also to varicosities around the orificium externum; fuaally there may occur partial or total prolapse of the mucosa.
The diagnosis of hyperwmia and catarrhal or virulent urethritis, can only be made with the aid of sight. The labia minora are to be spreaAl, all secretions carefully cleaned away, and the mucosa of the vulva and its neighborhood carefully inspected. Then the finger must be introduced int,o the vagina, and the urethral canal tested as to thickness, hardness, and sensibility. Pressure is then made upon it from before backwards, to express any fluid which may be in it. If urine has been recently voided, no fluid may be obtained, and some time must be permitted to elapla3 before pressure is again applied. The secretion thus obtained may be examined for gonococci with the microscope, to decide whether we have a simple or a virulent urethritis, or perchance a urethral chancre to deal with. Inoculation with virulent pus may cause virulent catarrh a,nd soft sores, but a negative result does not prove the absence of the chancre. The proof of its existence must chiefly depend upon the de monstration of elastic fibres in the secretion; though small and frequent urethral hemorrhages, with obstinate wdematous swelling of the mucous membmne around the meatus, have been claimed as important data in the diagnosis of urethml chancre. (V. Bitrensprung.) Swelling of the inguinal glands is important, and the occurrence of a bubo will help us in the diagnosis. Scanzoni claims as the seat of the acute hypertemias and inflammations the lower ind outer portions of the urethm, the inner and upper parts being the location of the chronic forms. On the other hand,
C. A. Martin and Leger claim that the coinmonest seat of chronic ure thritis is in the cryptis mucosis of the urethra and of the meatus uri narius.
Opinions differ much as to the occurrence of gonorrhcea in women. The syphilographers are authorities upon the matter, and we have already quoted Suchanek's figures. Boys de Loury and Costilhes also affirm that urethritis is not so uncommon as is thought. Ricord found it times in 12 gonorrhceas; but Zeisl only E to 6 times in a hundred cases of vaginal blenorrhcea. Lewin states that in 242 blenorrhceic women only 8 had urethritis, and in 612 cases of female pseudo-syphilis only 11, =1.8 per cent. had urethral sores. Sigmund (Vienna) found in 1850 in 758 women urethral gonorrhcea occurring only 5 times alone, but 476 times with other catarrhs, etc. Thus it seems that gonorrhcea is common in prosti tutes, and forms 1 of the total number of infected cases. Scanzoni re marks that chronic urethral catarrh especially is very often overlooked by gynecologists. Nevertheless I must agree with Hourmanu, that urethritis occurs but seldom in comparison with vaginal and uterine catarrhs. In 425 cases of blenorrhcna Hourmann found a urethral flow but once.
The prognosis in hyperwmias, catarrhs and sores of the female urethra, is much better than it is in corresponding affections in the male. The canal is shorter and more accessible, the disability is less, and the chances of cure are more numerous. In some individuals the hypenemia and the catarrh soon disappear when the cause that brought them on is removed. This is especially the case with the newly married, and in the cases that are connected with menstruation. Virulent catarrhs last 4 to 5 weeks. Boys Loury twice saw a tight stricture following one. Streubel saw in ne glected cases erosions, ulcerations, and that folliculitis to which we have above drawn attention. Knoblauch reckoned that the treatment of ure thral gonorrhcea took 21.8 days. Energetic cauterization has caused it to disappear in 12 to 18 days. (Cullerier.) Treatment. —There is yet considerable difference of opinion as tethe results of various methods of treatment in hypermmias and catarrhs of the female urethra. While Streubel, Boys de Loury, and Huet favor the use of balsams, opining that they render the urine bland more readily than in the male, and Boys and more recently Daffner claim that cubebs and balsam are just as efficacious as they are in man, Scauzoni obtained no results, and discarded them. The slighter cases of female urethral blen orrhcea need no treatment; they get well of themselves. Most recent authors rely entirely upon a local treatment for those that are more obsti nate, only general dietary rules being prescribed. We begin by removing the cause, and ordering rest, abstinence from intercourse, and cool muci laginous drinks. Milk of almonds, emulsions, and soft food are to be used. To relieve the burning and itching there should be given 2 to 4 vaginal injections of linseed tea daily, and lukewarm or cold sitz-baths containing decoction of white-oak bark should be taken. To further relieve the irritation and pain, we may use suppositories of cocao-butter or gelatine, or glycerine and starch, containing each extract of hyoscyamus 3 grs. or extract of belladonna gr. or extract of meconium gr. -116. Dr. Saxe (Cali fornia) recommends rest in bed, hot applications to the feet, and hot drinks, to favor diaphoresis; he orders calomel and ipecac i to 3 grs. every two hours; he moves the bowels with decoction of senna, and gives light diet and mucilaginous drinks. As sedative he applies cold cloths to the vulva, and gives opiates. If there is no improvement in twelve hours, he orders saline purgatives.