As previously stated, physicians do not as a rule see the earlier stages of infection in women, but are called in only when all the beacon fires are lighted and burning. Then they see miserable, suffering wrecks, panting with fever, with furred tongues and foul breath, with a history of serious menstrual troubles, with copious and purulent vaginal discharges, and dreading the pain of examination. In such cases it is almost always necessary to submit the patients to the severest surgical operations, cutting open their abdomens and removing the sexual organs as well as the pus sacs which have formed around them. Let us now shortly consider the favorite sites of gonorrhoeal infection in women.
GonorrJiceal Urethritis. The female urethra, contrary to former views, is more uniformly infected than any other part. The period of incubation two to five days and the general symptoms are much the same as in the male. At first there is a burning sensation during the prodromal stage, which becomes aggravated with the onset of the acute stage, during which a greenish yellow pus is poured out, excoriating the surfaces over which it flows.
The urethra in women, being a very short (two and a half to three inches) and almost straight tube, is very liable to become infected in its whole length, and by contiguity the bladder also is frequently involved. With the spread of the disease to the bladder there is great suffering, which amounts to agony, frequency of urination, and scalding of the tissues upon which the urine falls. The urethral discharge may remain infectious for months, and occasionally the inflammatory condition causes stricture, though not nearly so frequently as in the male. There is also great danger of septic infection of the kidneys, which of course induces invalidism and gravely menaces life.
Gonorrhoea! Vaginitis. The vagina is frequently the primary site of infection. There is the same yellowish green discharge, which slowly diminishes in amount and eventually disappears. The symptoms may be passed over unrecognized, or there may be intense pain and irritation.
A chronic gonorrhcea vaginitis vaginitis granulosa is very common in prostitutes, resulting in a characteristic roughened and leathery condition of the mucous membrane. Broese1 says: "One can scarcely err if he assumes that all prostitutes are infected with gonorrhoea, especially if they have exercised their profession for any length of time". This roughening of the vaginal mucous membrane in prostitutes is partly due to gonorrhoea and partly to the frequent use of astringent injections, employed with a view to make their vaginae appear virginal in size.
Gonorrhceal Invasion of Bartholin's Glands. Bartholin's glands (vulvo vaginal glands) are two glands situated on either side of the entrance to the vagina; each gland has a diameter of a little over half an inch, and each secretes a lubricating fluid which is poured out on the vulva just outside the hymen by the intervention of a duct of small calibre.
When gonococci invade these glands, through the ducts, they break down into pus sacs of about the size of a hen's egg and become exquisitely sensitive. It is an extremely obstinate affection, and recovery without surgical aid is not to be expected. The gonococci may remain indefinitely in these glands, and often the only evidence of chronic gonorrhoea in women lurks within them. The pus from them is highly infectious. This affection is very common in prostitutes.
Gonorrhoeal Invasion of the Uterus, Fallopian Tubes, Ovaries and Peritoneal Cavity. The gravity of the results when gonorrhoea spreads to the internal sexual organs has been sufficiently indicated in the preceding pages to render further elaboration unnecessary. If a woman contract this terrible disease we look upon it as a matter of course that the process will spread in time to her organs of procreation, unless treatment be successful in destroying all the gonococci. When once the Fallopian tubes, ovaries and peritoneum are involved, we are powerless to stop the ravages of the germs, and can only hold ourselves in readiness for the grave mutilating operation which in most cases becomes necessary in order to save life. The objection of unsexing the women does not apply in these cases, for the disease has already done that.
Residual, or Latent Symptoms of Gonorrhcea which are Characteristic. Gonorrhcea, unlike syphilis, leaves no deep scars, but nevertheless characteristic alterations are left on the surface of the mucous membranes, which render it possible for the expert to affirm that the woman has at some time had the disease. Saenger, of Leipsic, calls these chronic conditions "residual gonorrhoea", while others employ Noeggerath's term of "latent gonorrhoea". Instead of ulcers, as in syphilis, there are left behind certain inflammatory areas, which Professor Saenger calls "gonorrhoeal maculae". These pathological spots, or macules, remain for long periods of time, or even permanently, and from them there is a "migration", or exudation of leucocytes, or white blood corpuscles (phagocytes), within which gonococci are embedded.
As long as the specific infection remains localized in the vagina and other external parts of the sexual apparatus there is no great menace to the patient's health or life, apparently, but on account of the periodicity in women the disease, as pointed out heretofore, is always liable to invade the internal organs of procreation, and almost certain to do so if the woman become pregnant. In pregnancy the enlargement of the uterus facilitates the spread of the disease by opening up the passages of communication, and especially after childbirth or a miscarriage there is almost a certainty that the cavity of the uterus will become involved, owing to the physiological denudation at the placental site whereby an open wound is left.