Among the more common complications is yonorrhwal arthritis, which most often affects the wrist and tarsus, and less frequently the jaw-, finger-, and toe-joints. The symptoms are pain and swelling of the joints. In addition we may see tendovaginitis, and an extremely rare gonorrliceal stomatitis. Paulsen IlaS deseribed a gonorrIneal exanthem, with the. formation of blisters and pustules, the occurrence of which is said not to be so very ram.
The prognosis is serious in so far as thc disea.se is persistent and frequently relapses. Even though it be true that a cure is generally effected after some months, it must not be forgotten in our estimate of the prognosis that death someth»es occurs from the complications, and that the disorder may be accompanied by diseases of the genital organs which may show themselves only at the age of puberty (endo met rids, etc.).
Prophylaxis.—The readiness with which girls may be infected by the gonococcus indicates that the prophylaxis should attempt in every possible way to prevent exposure. Epstein proposes that the vulva should be earefully cleansed in the first bath given after birth, and that, if there is any suspicion of gonorrhcca in the mother, there be allowed to trickle into the vagina a 2 per cent. solution of silver. In addition all who nurse the mother and child should be instructed to attend to the child first and the mother afterwards, and that they observe at all times the mo.st rigorous antisepsis, just. as in a surgical operation. If we wish to avoid all danger of spreading the infection, the utmost cleanliness, the most careful antisepsis, and the strict prohibition of the use of the same towels, crockery, or sponges are absolutely necessary. Especially in hospitals, infirmaries, and boarding schools, where many girls sleep together, are the most energetic precautions necessary.
Kaplik is right in demanding that every newly admitted child should be submitted to a bacteriological examination of the secretion of the vulva and vagina, in order to know the possible origin of infection, and if necessary to isolate the case at once.
Treatment.—This consists in repeated and thorough cleansing of the genitals. Once or twice a day a sita bath in a l-1000 solution of tannic acid is given. As long as there are still more or less acute symp toms, it is possible to effect a cure in the course of one or two months by these means, combined with rest in bed, alone. It is questionable whether irrigation of the vagina, which is proposed by some, is of great benefit or cures the disease any sootier. And it may be mentioned that injections in the vagina often cause severe pain to some of the children, and moreover, it is apt to turn the child's attention to the genital appa ratus, which is very undesirable from a pedagogical standpoint. For use with the syringe there have been proposed a 0.5 per cent. solution of protargol, a 0.5 per cent. solution of sublimate, a rose red premanga nate solution. The injection of the vagina should only be done by the physician himself, and he should employ a syringe protected by a soft rubber tip. After the injection a tampon or small rod of iodoform may be introduced into the vagina. Perhaps a still better thing is the intro duction of a tampon saturated with a. 10 per cent. solution of ichthyol, which is squeezed out into the vagina. Small doses of sandal oil may be given internally. It is necessary to protect the eyes against the pos sibility of infection. Where there is inflammation of the upper genital tracts, the strictest rest in bed is imperative. Conorrineal arthritis is probably best treated by Bier's method.