Treatment ought to be directed to the cause of the disorder. In states of bad general health efforts must be made to improve the general health. For such a purpose the bowels must be regulated, preferably by such a gentle medicine as a mineral water, for example, a wine-glassful of Hunyadi Janos each morning. A moderate amount of exercise should be ob tained daily. Overwork of every kind is most injurious, whether in the case of the married woman who has a house and children to look after, or in that of the girl who has some busi ness occupation in the workshop, warehouse, office, or school, or in the case of the girl going in for the higher education. Easily digested, nourishing food is essential. Change of air and sea-bathing are very valuable, and quinine and iron tonics ought to be administered. In the way of direct treatment to the parts the person should restrict herself, failing advice, to simple measures. Warm-water injections, and injec tions of a lotion of sulphate of zinc (2 grains of sulphate of zinc to 1 ounce of water), are useful, or injections of iron-alum of the same strength. If the discharge be irritating, an injection of a lotion containing ounce of car bonate of soda (baking soda) to 1 pint of water affords great relief. If such measures fail, com petent advice must be obtained. Indeed, where at all possible, such advice ought to be obtained from the commencement, as the inflammation may extend up into the womb and onwards to the ovaries, or to the bladder, and lead to very serious consequences.
Fistula implies the existence of some unusual communication between the genital passage and the lower end of the bowel on one side, or between the genital passage and the urinary bladder on the other. The former is called recto-vaginal fistula, and the latter vesico vaginal fistula. The commonest cause of both arises in the course of labour. It may be that the rent occurs in the process of delivery either with or without instruments, from the narrow ness of the passage and the want of stretching capacity, or from the size of the child. In such cases it is commonly the partition between the genital canal and the bowel that gives way. It may result from long-delayed labour, when the head of the child becomes fixed, and long continued pressure is maintained upon some part of the walls. In such a case it is usually the division between the passage and the bladder that yields. Part of the wall has become se damaged by the pressure that, some time after delivery, a day or two or a week or two, it separates and comes away as a slough, leaving an opening, through which the urine from the bladder finds its way into the passage. While
the former misfortune may occur even with the most careful and skilled management, the latter is commonly the result of mismanage ment, undue delay having been allowed to occur in the use of instruments or other means of hastening delivery. The same unusual com munications may be opened up by the bursting of abscesses, by prolonged ulceration, by de struction of parts owing to cancerous disease, by wounds, and so on. But these are less fre quent causes than those above mentioned. In the case of the opening between the bowel and passage, matters from the bowel will be passed by the genital opening, and in the case of com munication with the bladder, urine will dribble away in an unusual manner. Other results follow. The presence of discharges in the genital passage foreign to it almost certainly occasions some degree of inflammation, extend big to the external parts, which become inflamed and ulcerated, and occasion much misery by their constant smarting and itching.
Treatment of such conditions has become much more hopeful in recent years, due mainly to the skill of American surgeons, Emmet and Marion Sims. The treatment consists in all operation for reuniting the edges of the tear. It is, of course, in cases where the rent is com paratively simple, as in those arising during child-birth, that the treatment is likely to be adopted, and not in fistulae the result of can cerous ulceration.
Tumours and Growths of various kinds may occur in connection with the external parts of the genital organs or in connection with the genital passage.
Abscess may form on one side of the exter nal opening large enough to block the opening, and may appear to the unskilled as a solid growth instead of a mere collection of matter. Such might occur as a result of inflammation, or from some slight blow or bruise, or even from such a slight cause as the tearing out of a hair.
Rupture. may occur in a similar situation, though it is rare, forming a swelling due to a loop of bowel passing down from the abdo men into a position similar to that which it occupies in the male (see p. 267). To mistake this for an abscess would be very serious indeed. It can be reduced and prevented from returning by the use of a properly fitting truss.