VULVA. — Gonorrhoea of the vulva may be a primary affection and may ex ist without the involvement of the other parts, it may transmit the disease to either the urethra or vagina, or it• may have been complicated by infection of one of these canals from the beginning. It is rarely met with in adult life, but is seen more frequently in young girls, who become infected either during an attempt at coitus or by mediate conta The symptoms appear in one or two days after infection. The vulva is swelled, red, and hot, and a. free dis charge issues from between the labia majora. rpon separating these, the labia minora are seen to be much swelled and covered with pus. There may also be superficial erosions. The patient ex periences severe burning pain in the parts, and the urine, in passing over the inflamed area, causes very acute suffer ing.
In the treatment rest and cleanliness are the first essentials. Frequent and thorough bathing of the entire inflamed surface with water, as warm as can be tolerated, comfortably, to which has been added some bicarbonate of soda, or borax, will give great relief. Warm so lution of potassium permanganate, 1 to :1 grains to a pint, is also useful. Pieces of absorbent lint or cotton wet with a mixture of 1 or 2 drachms of the aque ous extract of opium to pint of dilute lead-water may then be applied to the inflamed surfaces. The vagina should be irrigated through a soft-rubber cath eter with one of the above lotions. Solution of silver nitrate, 10 to 30 grains to an ounce of distilled water, applied once or twice daily, after the cleansing, has a very beneficial effect on the in flamed mucous membranes. As the con dition improves, more astringent lotions may be substituted. Chlorate of potash, alum, and zinc sulphate are all useful. If an abscess of Ilartholin's gland de velops, it must be opened freely and the cavity packed with gauze.
VAGINA.—Gonorriacea of the vagina is rare in adults, and when present usually affects young girls. It may exist with
a similar affection of the urethra, the vulva, or both. The chief symptom is a profuse purulent discharge. It is to be treated on the lines already laid down. Sometimes, after cleansing, tampons of boroglyceride in combination with mild antiseptics or astringents are very useful. For inspection as well as for local appli cations the knee-chest position gives a much better exposure than any other, and is to be recommended.
CEnvix.—Gonorrhea of the cervix uteri is the most serious form of the dis ease, inasmuch as it may extend upward, involving the uterus, the Fallopian tubes, the ovaries, and may give rise to peritonitis. Nor is the danger over when the acute symptoms have subsided. The disease may remain latent in the cervix for a long time, ready to assume a fresh virulence and to spread to other struct ures nnder favorable conditions.
The symptoms are variable and by no means characteristic. The mucous membrane is applied so firmly to the uterus with no loose submucous tissue intervening that it does not respond to gonorrhoeal infection in the same man ner as does that of the other regions mentioned. There is but a moderate amount of discharge, thus contrasting strikingly with the other forms men- , tioned, and might easily escape notice, especially with those who had had a previous lencorrheea. In the more se vere cases there may be a feeling of fullness or weight in the pelvis, which is in creased by exercise. Menstruation is apt to be more frequent and more profuse than normal, and may be unusually pain ful. If the cervix be examined, it will be found to be swelled and of a deeper red than normal, with the os somewhat everted, or pouting. A tenacious secre tion of muco-pus will be seen issuing from the os and bathing the adjacent parts. The mucous membrane around the os may have exfoliated, leaving an eroded or ulcerated surface. Such con ditions may exist for an indefinite period.