—A case of acute gonorrheal vaginitis with its accompaniments will present a difficult problem. The discharge is so great that the danger to others, and especially to the eyes, is pronounced, while the exquisite tenderness of the parts makes radical treatment difficult. The treatment should consist of antiseptic douches, which in serious cases should be made as nearly continuous as possible. The water used for the purpose should be as warm as the patient can tolerate, and contain an antiseptic, of which corrosive sublimate, in strength of 1 to 2000, silver nitrate in the same strength, or formalin in double this strength, are the most serviceable. The irrigating tube should be carried to the upper end of the vagina and the stream made to flow outward. In milder cases a douche at intervals through the day may suffice. The vaginal surface should later be exposed through a speculum and the entire mucous surface treated with nitrate of silver solution in from 6 to 10 per cent. strength. Should the surface be tender, this will be painful, and might justify the use of an anesthetic, especially of nitrous oxide.
If the disease extend upward and there is an endometritis or a salpingitis, external applications of ice may be used to lull the pain; but probably hot poultices or some application of external heat might afford greater comfort to the patient. Byford has used succinic dioxide in the treatment of specific vaginitis with great satisfaction. It is sold in the open market under the trade name “Alphozone.”
The edema of the vulva will subside with the general improvement of the case. Abscesses in the vulvovaginal glands are not uncommon. These are easily recognized, are often painful, and should be incised early or as soon as recognized, cleaned out thoroughly, the interior of the cavity cauterized to prevent the result of fresh infection, and then packed and left to heal by granulation.
Urethritis and cystitis may be treated as when they occur in the male. There is the same liability in women as in men to lymphatic involvement, with the consequent bubo, which may perhaps suppurate. They are less liable to the widespread manifestations of postgonorrheal infections of the joints, etc., although they are even more liable to infection of the endocardium, and, as will be readily understood, more so to infection of the peritoneum. It will then be seen that the treatment of the disease is essentially the same in either sex, certain differences in method rather than in principle having to be made in accordance with anatomical requirements.
As to the rectal mucous membrane participating in gonorrheal infection, under ordinary circumstances it would escape. In the treatment of any of these cases by the sitz bath, the question might arise whether there would be danger of extending the contagion in this direction. It does not appear that much fear need be felt, for two reasons: the grasp of the sphincter is usually sufficient to prevent entrance of fluid, and, furthermore, the rectal mucosa is itself extremely resistant to the gonococcus. Gonorrheal proctitis is an exceedingly uncommon infection, and one rarely seen, except in extreme cases of sexual perversion. It should be treated in about the same manner as gonorrheal vaginitis, i. e., by continuous irrigation with hot water, and stretching the sphincter in order to overcome the spasm into which it would be thrown by reflex activity.
Gonorrheal urethritis in women is best treated with local applications of argyrol or one of the other silver compounds. These can be made with a syringe or with a small swab. Cystitis is to be treated in the same manner as when it occurs in the male.
CHAPTER XIII.
SCURVY AND RICKETS.
SCURVY.
Scurvy is placed among the so-called surgical diseases, since it manifests many distinctly surgical features and is possibly of parasitic character, although this feature of its existence has not been incontrovertibly established. It is a starvation disease, its principal characteristic being that of malassimilation, accompanied by profound anemia. Well-marked cases are seen during long sieges, like that of Paris, in 1871, or during long imprisonment, as in Andersonville prison. It has certain points of resemblance to that condition of multiple neuritis met with in warm climates, and known usually as beriberi. The former is apparently due to the absence of a vegetable regimen, while beriberi is largely due to the absence of an animal regimen, nature having intended that man’s diet should be mixed, and having ordained that suffering and disease always follow confinement to one or the other.