Gonorrhoea in the Female is a much more serious disease than is generally recognised, owing to the grave complications which may arise in the pelvis even when the vaginal or urethral symptoms are latent. The routine of injecting the vagina is open to the danger of infecting the uterus, and it roust be carried out with care. Ilierhoff's method of abortive treatment is carried out by thoroughly disinfecting the urethra and vulva and irrigating the vagina with a I per cent. Protargol solution, after which the latter is thoroughly cleansed by mopping with cotton-wool, and if no gonococci are found in a scraping from the cervical canal the vagina is to be packed with gauze soaked in the solution and a 5 per cent. protargol bougie LI inches long is inserted into the urethra. The tampon is left in situ for 24 hours, and the bougie allowed to remain in the urethra by directing the patient not to pass water for 2 hours. The plugging is renewed after a Sitz-bath, and fresh irrigation performed upon removing the second tampon. Daily irrigation of the vagina is to be carried out by
a z in 4,000 Perchloride of Mercury or a per cent. Sulphocarbolate of Zinc solution. Where the vagina is found to be infected at the start a 5 per cent. Protargol irrigation is to be used before plugging the canal. A good and safe routine is to flush out the vagina with a strong Perman ganate or weak Iodine lotion after swabbing with Peroxide of Hydrogen.
Where the cervix has become infected in chronic cases, curetting of the canal should he carried out before plugging it with 2 per cent. protargol. The urethra should be dilated by a Kelly's speculum, and the bladder swabbed or irrigated by Nitrate of Silver solution when cystitis is present, and Sandal-Wood Oil should he given. Abscesses arising from suppura tion of llartholin's gland should be opened early.
Vaccine treatment is of value in these complications. Pyosalpinx is to be treated by removal of the tubes with or without the ovaries, as detailed under its own heading.